Kits for the detection of beta-lactamases

ABSTRACT

Presented herein are kits for the detection of specific beta-lactamases, including class A serine carbapenemases, metallo-beta-lactamases, AmpC beta-lactamases, and extended-spectrum beta-lactamases (ESBLs). The kits presented herein include kits that permit the detection of the presence of specific beta-lactamases in bacterial samples within as few as 2 to 10 minutes.

This application is a divisional of U.S. patent application Ser. No.12/254,594, filed Oct. 20, 2008, now U.S. Pat. No. 8,097,434, whichclaims priority under 35 U.S.C. §119(e) to U.S. provisional applicationSer. No. 60/981,156, filed Oct. 19, 2007, each of which is incorporatedherein by reference in its entirety.

1. INTRODUCTION

Presented herein are methods and compositions for the detection ofspecific beta-lactamases, including class A serine carbapenemases,metallo-beta-lactamases, AmpC beta-lactamases, and extended-spectrumbeta-lactamases (ESBLs). The methods presented herein include methodsthat permit the detection of the presence of specific beta-lactamases inbacterial samples within as few as 2 to 10 minutes.

2. BACKGROUND

Beta-lactamases are a family of enzymes that hydrolyze beta-lactamrings, such as beta-lactam rings of beta-lactam antibiotic drugs.Beta-lactamases are found in gram positive and gram negative bacteriaand are responsible for the antibiotic resistance of many bacterialstrains.

Beta-lactamases can be classified on the basis of their primarystructure into four molecular classes, namely classes A to D. Classes A,C and D have a serine residue at their active site and class B, ormetallo-beta-lactamases, have zinc at their active site. Carbapenemasesare a diverse group of beta-lactamases that include enzymes belonging toclass A, B and D. Class A carbapenemases include KPC-1, KPC-2, KPC-3 andKPC-4. Class B carbapenemases include the IMP family, VIM family, GIM-1and SPM-1 as well as others. Class D carbapenemases include OXA-23,OXA-24, OXA-25, OXA-26, OXA-27, OXA-40 and OXA-40 as well as others.AmpC beta-lactamases are class C enzymes and can be encoded bychromosomal genes or be plasmid-borne. AmpC beta-lactamases hydrolyzebroad and extended-spectrum cephalosporins cephamycins andoxyimino-beta-lactams). Extended-spectrum beta-lactamases (ESBLs) arebeta-lactamases that hydrolyze cephalosporins with an oxyimino chain.ESBLs include the TEM family, SHV family as well as others, and CTX-Mfamily, which are class A enzymes. Original-spectrum beta-lactamases(OSBLs) include class A enzymes.

The spread of beta-lactamases between bacteria has increased theresistance of bacteria to beta-lactam drugs. The administration ofbeta-lactam drugs to patients with bacteria resistant to those drugsselects for those bacteria and leads to an increase in the transmissionof beta-lactamases. Thus, there is a need to rapidly detect bacteriaexpressing specific beta-lactamases so that an appropriate therapeuticregimen is selected for a given patient and the likelihood of the spreadof resistant bacteria is reduced.

3. SUMMARY

In one aspect, presented herein are methods for the rapid detection ofparticular beta-lactamases using a detectable beta-lactamase substrateand certain beta-lactamase inhibitors. For example, presented herein aremethods for the rapid detection of serine carbapenemases,metallo-beta-lactamases, AmpC, and extended-spectrum beta-lactamases(ESBLs). Some methods presented herein do not require the production ofa bacterial cell extract and some methods presented herein only requirea small amount of a bacterial sample (e.g., less than 10¹⁰ CFU or lessthan 10⁸ CFU of bacteria). Further, methods presented herein permit thedetection of the presence of such beta-lactamases in bacterial sampleswithin as few as 2 to 10 minutes. Detection of the presence of thebeta-lactamases can provide information for the selection of theappropriate therapeutic regimen for a patient with a bacterialinfection.

The methods presented herein can comprise: (a) contacting two or morebacterial samples from the same source with different compositionscomprising a detectable beta-lactamase substrate (e.g., nitrocefin) andone or more beta-lactamase inhibitors; and (b) detecting utilization ofthe substrate in the compositions, wherein the utilization of thesubstrate in the compositions indicates whether the presence of the oneor more inhibitors inhibits the beta-lactamase(s) present in thebacterial source. Via the results of the different compositions, thepresence of certain beta-lactamases in the bacterial source can bedetermined and the presence of other beta-lactamases can be excluded.Different compositions comprising a detectable beta-lactamase substrateand one or more beta-lactamase inhibitors can be contacted with abacterial sample from the same source simultaneously or sequentially.The compositions can be presented in any type of carrying vessel ordevice amenable to detection of substrate utilization following contactof the composition with a bacterial sample. For example, thecompositions may be presented in the form of a liquid composition,embedded in an agar plate, a paper disk, a paper strip or a dry form inwells or tubes. In a specific embodiment, the beta-lactamase inhibitorsincluded in one or more of the compositions are a serine beta-lactamaseinhibitor, an AmpC inhibitor, a metal chelator and/or an ESBL inhibitor.

The methods and compositions presented herein are based, in part, on thediscovery that particular concentrations of beta-lactamase inhibitorscan affect its inhibition ability on different beta-lactamases insurprising, unpredictable ways. For example, clavulanic acid at certainconcentrations inhibits ESBLs and original-spectrum beta-lactamases(OSBLs) but not class A serine carbapenemases. The inventors, e.g.,discovered that the presence of class A serine carbapenemases in abacterial sample can be differentiated from the presence of ESBLs andOSBLs in a bacterial sample by using certain concentrations ofclavulanic acid. The inventors also discovered that a cloxacillininhibitor at certain concentrations inhibits class A beta-lactamases aswell as class C beta-lactamases.

In one embodiment, presented herein is a method for detecting thepresence of a beta-lactamase, comprising: (a) contacting: (i) a firstbacterial sample with a first composition comprising a detectablebeta-lactamase substrate and an AmpC inhibitor, and (ii) a secondbacterial sample with a second composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase, wherein the first and second bacterialsamples are from the same source; and (b) detecting utilization of thesubstrate in the first composition and the second composition, such thata beta-lactamase that is a class A serine carbapenemase or ametallo-beta-lactamase is detected if the substrate has been utilized inthe first and second compositions.

To differentiate between the presence of a serine carbapenemase and ametallo-beta-lactamase, a third bacterial sample from the same source asthe first and second bacterial samples can be contacted with a thirdcomposition comprising a detectable beta-lactamase substrate, an AmpCinhibitor, a serine beta-lactamase inhibitor in an amount sufficient toinhibit an ESBL and an OSBL but not a class A serine carbapenemase, anda metal chelator, and the utilization of the substrate in the thirdcomposition is detected. If substrate utilization in the thirdcomposition as well as in the first and second compositions is detected,then the presence of a class A serine carbapenemase is detected in thebacterial source. If, on the other hand, there is no substrateutilization detected in third composition but there is substrateutilization detected in the first and second compositions, then thepresence of a metallo-beta-lactamase is detected in the bacterialsource. If no substrate utilization is detected in the third compositionbut substrate utilization in the first and second compositions isdetected, then the presence of a class A serine carbapenemase can beexcluded.

In another embodiment, presented herein is a method for detecting abeta-lactamase, comprising: (a) contacting: (i) a first bacterial samplewith a first composition comprising a detectable beta-lactamasesubstrate, and (ii) a second bacterial sample with a second compositioncomprising a detectable beta-lactamase substrate and a metal chelator,wherein the first and second bacterial samples are from the same source;and (b) detecting utilization of the substrate in the first compositionand the second composition such that: (i) a beta-lactamase other than ametallo-beta-lactamase is detected if the substrate in the firstcomposition and the second composition has been utilized, and (ii) abeta-lactamase that is a metallo-beta-lactamase is detected if thesubstrate in the first composition has been utilized but the substratein the second composition has not been utilized. In addition, thefailure to detect substrate utilization by the first compositionindicates that there is no beta-lactamase present in the bacterialsource.

In another embodiment, presented herein is a method for detecting abeta-lactamase, comprising: (a) contacting: (i) a first bacterial samplewith a first composition comprising a detectable beta-lactamasesubstrate and an AmpC inhibitor, (ii) a second bacterial sample with asecond composition comprising a detectable beta-lactamase substrate, anAmpC inhibitor, and a serine beta-lactamase inhibitor in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase, (iii) a third bacterial sample with a third compositioncomprising a detectable beta-lactamase substrate, an AmpC inhibitor, aserine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, and a metalchelator, and (iv) a fourth bacterial sample with a fourth compositioncomprising a detectable beta-lactamase substrate and a serinebeta-lactamase inhibitor in an amount sufficient to inhibit an ESBL andan OSBL but not a class A serine carbapenemase, wherein the first,second, third and fourth bacterial samples are from the same source; and(b) detecting utilization of the substrate in the first composition, thesecond composition, the third composition, and the fourth compositionsuch that: (i) a beta-lactamase that is a class A serine carbapenemaseis detected if the substrate in the first composition, the secondcomposition, the third composition and the fourth composition has beenutilized; (ii) a beta-lactamase that is a metallo-beta-lactamase isdetected if the substrate in the first composition, the secondcomposition, and the fourth composition has been utilized but thesubstrate in the third composition has not been utilized, and (iii) abeta-lactamase that is an AmpC beta-lactamase is detected if thesubstrate in the fourth composition has been utilized but the substratein the first composition, the second composition, and the thirdcomposition has not been utilized. In addition, the detection ofsubstrate utilization in the first, second and fourth compositions butthe failure to detect substrate utilization in the third compositionindicates that a class A serine carbapenemase is not present in thebacterial source. Further, the detection of substrate utilization infourth composition but the failure to detect substrate utilization inthe first, second and third compositions indicates that a class A serinecarbapenemase, a metallo-beta-lactamase and an ESBL are not present inthe bacterial source.

In yet another embodiment, presented herein is a method for detectingthe presence of a beta-lactamase, comprising: (a) contacting: (i) afirst bacterial sample with a first composition comprising a detectablebeta-lactamase substrate and an AmpC inhibitor, (ii) a second bacterialsample with a second composition comprising a detectable beta-lactamasesubstrate, an AmpC inhibitor, and a serine beta-lactamase inhibitor inan amount sufficient to inhibit an ESBL and an OSBL but not a class Aserine carbapenemase, (iii) a third bacterial sample with a thirdcomposition comprising a detectable beta-lactamase substrate, an AmpCinhibitor, a serine beta-lactamase inhibitor in an amount sufficient toinhibit an ESBL and an OSBL but not a class A serine carbapenemase, anda metal chelator, (iv) a fourth bacterial sample with a fourthcomposition comprising a detectable beta-lactamase substrate and aserine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, and (v) a fifthbacterial sample with a fifth composition comprising a detectablebeta-lactamase substrate and an ESBL inhibitor, wherein the first,second, third, fourth and fifth bacterial samples are from the samesource; and (b) detecting utilization of the substrate in the firstcomposition, the second composition, the third composition, the fourthcomposition, and fifth composition such that: (i) a beta-lactamase thatis an ESBL is detected if the substrate in the first composition hasbeen utilized but the substrate in the second composition, the thirdcomposition, the fourth composition, and the fifth composition has notbeen utilized, (ii) a beta-lactamase that is an AmpC beta-lactamase isdetected if the substrate in the fourth composition has been utilizedbut the substrate in the first composition, the second composition andthe third composition has not been utilized, (iii) a beta-lactamase thatis a metallo-beta-lactamase is detected if the substrate in the firstcomposition, the second composition, and the fourth composition has beenutilized but the substrate in the third composition has not beenutilized, and (iv) a beta-lactamase that is a class A serinecarbapenemase is detected if the substrate in the first composition, thesecond composition, the third composition, and the fourth compositionhas been utilized. In addition, the detection of substrate utilizationin the first composition but the failure to detect substrate utilizationin the second, third, fourth and fifth compositions indicates that aclass A serine carbapenemase, a metallo-beta-lactamase, and an AmpCbeta-lactamase are not present in the bacterial source. In addition, thedetection of substrate utilization in the first, second and fourthcompositions but the failure to detect substrate utilization in thethird composition indicates that a class A serine carbapenemase is notpresent in the bacterial source. Further, the detection of substrateutilization in the fourth composition but the failure to detectsubstrate utilization in the first, second and third compositionsindicates that a class A serine carbapenemase, a metallo-beta-lactamaseand an ESBL are not present in the bacterial source.

In certain embodiments, the compositions used in accordance with themethods described herein comprise a lysis reagent. Lysis reagents (e.g.,a lysis reagent in a buffer) are known to one of skill in the art. In aspecific embodiment, the lysis reagent lyses or promotes lysis of thebacterial cells but does not interfere with either the hydrolysis of thebeta-lactamase substrate or the activity of one or more beta-lactamaseinhibitors, or both. In one embodiment, the lysis reagent is an enzymeor other agent that promotes the lysis of a bacterial cell. Non-limitingexamples of such an enzyme include lysozyme, labiase, lysostaphin,achromopeptidase, and mutanolysin. In a specific embodiment, thecompositions used in accordance with the methods described hereincomprise lysozyme.

In certain embodiments, the compositions used in accordance with themethods described herein comprise a lysis reagent and an agent thatpromotes the stabilization of the lysis reagent. In one embodiment, theagent that promotes stabilization of the lysis reagent is thermalstable. In a specific embodiment, the compositions used in accordancewith the methods described herein comprise a lysis reagent and acarbohydrate, e.g., a monosaccharide, a disaccharide, a polysaccharide,an oligosaccharide, or a polyol. Specific examples of carbohydratesinclude, but are not limited to, mannitol, ribose, glucose, fructose,mannose, sucrose, lactose, glycerol, Xanthan gum, trehalose and glycols(e.g., propylene glycol). In a specific embodiment, the compositionsused in accordance with the methods described herein comprise lysozymeand trehalose.

In certain embodiments, the compositions used in accordance with themethods described herein comprise a lysis reagent, an agent thatpromotes stabilization of the lysis reagent, and an additional agent,e.g., an agent that enhances the lysis of a bacterial cell by a lysisreagent (e.g. a metal chelator). In a specific embodiment, theadditional agent is EDTA or EGTA. In particular embodiments, either EDTAor EGTA, or both are not utilized if a metallo-beta-lactamase is or maybe detected. In a specific embodiment, the compositions used inaccordance with the methods described herein comprise a lysozyme,trehalose and EDTA.

In some embodiments, the compositions used in accordance with themethods described herein are in the form of a liquid composition, anagar plate, a paper strip, a paper disk, a tablet, a dry form in wells,or a dry form in one or more tubes, e.g., an array of tubes. In someembodiments, the compositions used in accordance with the methodsdescribed herein are dried and are present on or in a solid support,such as the wells of a plate, a tray, a cassette or a panel, a paperstrip, a paper disk, or a tube (e.g., a test tube or Eppendorf tube). Incertain embodiments, the compositions used in accordance with themethods described herein are dried and are present in the wells of apanel, cassette, tray or plate (e.g., a microtiter plate). In specificembodiments, the compositions used in accordance with the methodsdescribed herein are dried and are present in the wells of a Phoenix™Panel (BD, USA) or the wells of a panel from a BBLT™ Crystal™Identification System (BD, UDA). In other embodiments, the compositionsused in accordance with the methods described herein are dried and arepresent in the wells of a Vitek® card (bioMerieux, USA). In otherembodiments, the compositions used in accordance with the methodsdescribed herein are dried and present in the wells of a MicroScan panel(Dade Behring, USA). In other embodiments, the compositions used inaccordance with the methods described herein are dried and are presentin tubes of an API biochemical test (bioMerieux, USA). In otherembodiments, the compositions used in accordance with the methodsdescribed herein are dried and are present in the wells of a panel of aRemel RapID™ System (Remel, USA).

In another aspect, presented herein are kits for detecting the presenceof particular beta-lactamases. In one embodiment, the kits comprise, inone or more containers: (a) a first composition comprising a detectablebeta-lactamase substrate and an AmpC inhibitor; and (b) a secondcomposition comprising a detectable beta-lactamase substrate, an AmpCinhibitor, and a serine beta-lactamase inhibitor in an amount sufficientto inhibit an ESBL, and an OSBL but not a class A serine carbapenemase.In some embodiments, the kits further comprise a third compositioncomprising a detectable beta-lactamase substrate, a an AmpC inhibitor, aserine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, and a metalchelator. In some embodiments, the kits further comprise a fourthcomposition comprising a detectable beta-lactamase substrate and aserine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase. In someembodiments, the kits further comprise a fifth composition comprising adetectable beta-lactamase substrate and an ESBL inhibitor.

In another embodiment, the kits comprise, in one or more containers: (a)a first composition comprising a detectable beta-lactamase substrate andan AmpC inhibitor; (b) a second composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase; and (c) a third composition comprising adetectable beta-lactamase substrate and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase. In other embodiments, the kits comprise,in one or more containers: (a) a first composition comprising adetectable beta-lactamase substrate and an AmpC inhibitor; (b) a secondcomposition comprising a detectable beta-lactamase substrate, an AmpCinhibitor, and a serine beta-lactamase inhibitor in an amount sufficientto inhibit an ESBL and an OSBL but not a class A serine carbapenemase;and (c) a third composition comprising a detectable beta-lactamasesubstrate and an ESBL inhibitor. In some embodiments, the kits comprise,in one or more containers: (a) a first composition comprising adetectable beta-lactamase substrate; and (b) a second compositioncomprising a detectable beta-lactamase substrate and a metal chelator.

In some embodiments, the kits described herein contain a compositioncomprising a lysis reagent. In certain embodiments, in addition to abeta-lactamase substrate and in some embodiments, one or morebeta-lactamase inhibitors, the compositions in the kits described hereincomprise a lysis reagent. In a specific embodiment, the lysis reagentlyses the bacterial cells but does not interfere with either thehydrolysis of the beta-lactamase substrate or the activity of one ormore beta-lactamase inhibitors, or both. In one embodiment, the lysisreagent is a detergent, such as mild non-denaturing detergent (e.g.,Triton® X-100 or CHAPS). In another embodiment, the lysis reagent is anenzyme or other agent that promotes the lysis of a bacterial cell.Non-limiting examples of such an enzyme include lysozyme, labiase,lysostaphin, achromopeptidase, and mutanolysin.

In some embodiments, the kits described herein contain a compositioncomprising a lysis reagent and an agent that promotes the stabilizationof the lysis reagent. In certain embodiments, in addition to abeta-lactamase subtrate and in some embodiments, one or morebeta-lactamase inhibitors, the compositions in the kits described hereincomprise a lysis reagent and an agent that promotes the stabilization ofthe lysis reagent. In one embodiment, the agent that promotes thestabilization of the lysis reagent is thermal stable.

In a specific embodiment, the kits described herein contain acomposition comprising a lysis reagent and a carbohydrate, e.g., amonosaccharide, a disaccharide, a polysaccharide, an oligosaccharide, ora polyol. Specific examples of carbohydrates include, but are notlimited to, mannitol, ribose, glucose, fructose, mannose, sucrose,lactose, glycerol, Xanthan gum, trehalose and glycols (e.g., propyleneglycol). In a specific embodiment, the compositions in the kitsdescribed herein comprise lysozyme and trehalose.

In some embodiments, the kits described herein contain a compositioncomprising a lysis reagent, an agent that promotes the stabilization ofthe lysis reagent, and an additional agent, e.g., an agent that enhancesthe lysis of a bacterial cell by a lysis reagent (e.g., a metalchelator). In a specific embodiment, the additional agent is EDTA orEGTA. In particular embodiments, either EDTA or EGTA, or both are notutilized if a metallo-beta-lactamase is or may be detected. In aspecific embodiment, the compositions in the kits described hereincomprise a lysozyme, trehalose and EDTA.

In some embodiments, the compositions in the kits described herein arein the form of a liquid composition, an agar plate, a paper strip, apaper disk, a tablet, a dry form in wells, or a dry form in one or moretubes, e.g., an array of tubes. In some embodiments, the compositionsused in accordance with the methods described herein are dried and arepresent on or in a solid support, such as a well of a plate, a tray, acassette or a panel, a paper strip, a paper disk or a tube (e.g., a testtube or Eppendorf tube). In certain embodiments, the compositions in thekits described herein are dried and are present in the wells of a panel,tray, cassette or plate (e.g., a microtiter plate). In specificembodiments, the compositions in the kits described herein are dried andare present in the wells of a Phoenix™ Panel (BD, USA) or the wells of apanel from a BBLT™ Crystal™ Identification System (BD, UDA). In otherembodiments, the compositions in the kits described herein are dried andare present in the wells of a Vitek® card (bioMerieux, USA). In otherembodiments, the compositions in the kits described herein are dried andare present in the wells of a MicroScan panel (Dade Behring, USA). Inother embodiments, the compositions in the kits described herein aredried and are present in tubes of an API biochemical test (bioMerieux,USA). In other embodiments, the compositions in the kits describedherein are dried the wells of a panel of a Remel RapID™ System (Remel,USA).

3.1 Terminology

As used herein, the terms “about” and “approximately”, unless otherwiseindicated, refer to a value that is no more than 20% above or below thevalue being modified by the term.

As used herein, the terms “agent that promotes the stabilization of thelysis reagent” and “agent that promotes the stabilization of a lysisreagent” refer to an agent that prevents the loss of a lysis reagent'sability to lyse bacterial cells after exposure to temperatures ofgreater than about 50° C. In a specific embodiment, the agent preventsthe loss of a lysis reagent's ability to lyse bacterial cells afterexposure to temperatures of about 50° C. to about 120° C., about 50° C.to about 100° C., about 50° C. to about 85° C., about 50° C. to about80° C., or about 60° C. to about 75° C. In another specific embodiment,the agent prevents the loss of a lysis reagent's ability to lysebacterial cells after exposure to temperatures of about 50° C. to about120° C., about 50° C. to about 100° C., about 50° C. to about 85° C.,about 50° C. to about 80° C., or about 60° C. to about 75° C. for atleast 5 minutes, at least 10 minutes, at least 15 minutes, at least 20minutes, at least 30 minutes, at least 45 minutes, at least 1 hour, atleast 1.5 hours or at least 2 hours. In another specific embodiment, theagent prevents the loss of a lysis reagent's ability to lyse bacterialcells after exposure to temperatures of about 50° C. to about 120° C.,about 50° C. to about 100° C., about 50° C. to about 85° C., about 50°C. to about 80° C., or about 60° C. to about 75° C. for about 2 minutesto about 3 hours, about 2 minutes to about 2 hours, about 2 minutes toabout 1 hour, about 2 minutes to about 30 minutes, about 2 minutes toabout 15 minutes, about 15 minutes to about 2 hours, about 15 minutes toabout 1.5 hours, about 15 minutes to about 1 hour, about 15 minutes toabout 45 minutes or about 15 minutes to about 30 minutes.

As used herein, the term “pure bacterial sample” means a samplecollected from one or more bacterial colonies from the same sourceresulting from streaking an agar-containing medium with a biologicalsample containing bacteria. When the sample is from more than onecolony, generally all of the colonies are from the same species.

As used herein, the term “same source” in the context of bacterialsamples means two or more bacterial samples that are isolated, obtainedor derived from a biological sample(s) from the same entity (e.g., ahuman subject). For example, two or more bacterial samples may beobtained from one, two or more tissues, organs or secretions from onesubject.

As used herein, the terms “subject” and “patient” are usedinterchangeably to refer to an animal subject. In a specific embodiment,the subject is a mammal. In another embodiment, the subject is anon-human. In a preferred embodiment, the subject is a human.

With respect to beta-lactamases, as used herein, the term “substrateutilization” means the hydrolysis of a substrate by a beta-lactamase.

4. DETAILED DESCRIPTION

4.1 Beta-Lactamase Assays

Presented herein are methods for the rapid detection of particularbeta-lactamases using compositions comprising a detectablebeta-lactamase substrate and one or more beta-lactamase inhibitors. Themethods presented herein can comprise: (a) contacting two or morebacterial samples from the same source with different compositionscomprising a detectable beta-lactamase substrate (e.g., nitrocefin) andone or more beta-lactamase inhibitors; and (b) detecting utilization ofthe substrate in the compositions, wherein the utilization of thesubstrate in the compositions indicates whether the presence of the oneor more inhibitors inhibits the beta-lactamase(s) present in thebacterial samples. Via the results of the different compositions, thepresence of certain beta-lactamases in the bacterial source can bedetermined and/or the presence of other beta-lactamases can be excluded.

The methods presented herein may, for example, comprise: (a) contacting:(i) a first bacterial sample with a first composition comprising adetectable beta-lactamase substrate and one or more beta-lactamaseinhibitors, and (ii) a second bacterial sample with a second compositioncomprising a detectable beta-lactamase substrate and one or morebeta-lactamase inhibitors, wherein at least one such beta-lactamaseinhibitor is different than the one or more beta-lactamase inhibitors inthe first composition, wherein the first and second bacterial samplesare from the same source; and (b) detecting utilization of the substratein the first composition and the second composition, wherein substrateutilization in the first composition and/or second composition indicatesthe presence of one or more particular beta-lactamases in the bacterialsource and in some instances, the absence of one or more particularbeta-lactamases. In a specific embodiment, a control compositioncomprising a detectable beta-lactamase substrate and no beta-lactamaseinhibitor is also contacted with a bacterial sample from the same sourceas the other compositions. Detection of substrate utilization in thiscontrol composition confirms that a beta-lactamase is present in thebacterial source. In some embodiments, a positive control comprising abacterial sample that is known to express one or more beta-lactamasesand/or a negative control comprising a bacterial sample that is knownnot to express one or more particular beta-lactamases is included in themethods presented herein.

In certain embodiments, the first composition, second composition andcontrol composition described in the preceding paragraph comprise alysis reagent. In a specific embodiment, the first composition, secondcomposition and control composition described in the preceding paragraphcomprise a lysis reagent and an agent that promotes the stabilization ofthe lysis reagent. In another embodiment, the first composition, secondcomposition and control composition described in the preceding paragraphcomprise a lysis reagent, an agent that promotes the stabilization ofthe lysis reagent, and an agent that enhances the lysis of a bacterialcell by a lysis reagent.

Table 1, below, provides an exemplary list of compositions that can beused to detect the presence of particular beta-lactamases in a bacterialsample and identifies beta-lactamases that can be detected based upondetection of substrate utilization in different compositions. Bycomparing substrate utilization when a bacterial sample from the samesource is contacted with different compositions, the presence of aparticular beta-lactamase can be detected and in some instances, thepresence of a particular beta-lactamase can be excluded.

In some embodiments, 1, 2, 3, 4, 5 or all of the compositions in Table1, below, are used to detect the presence of a particular beta-lactamasein a bacterial source. For example, in certain embodiments, a firstbacterial sample, a second bacterial sample and a third bacterial samplefrom the same source are contacted with composition #1, composition #4,and composition #5 in Table 1, below, respectively, and the utilizationof the substrate in the compositions is detected. If substrateutilization is detected in composition #1 and composition #4, butsubstrate utilization in composition #5 is not detected, then thepresence of a metallo-beta-lactamase is present in the bacterial source.If substrate utilization is detected in all three compositions, then aclass A serine carbapenemase is present in the bacterial source isdetected. If substrate utilization is detected in composition #1, butsubstrate utilization is not detected in compositions #4 and #5, then abeta-lactamase other than a class A serine carbapenemase and ametallo-beta-lactamase is present in the bacterial source.

TABLE 1 AmpC* + ESBL No OR detectable Class A Serine AmpC* + beta-Composition Carbapenemase MBL OSBL AmpC* ESBL OSBL lactamase Composition++ ++ ++ ++ +/++ +/++ − # 1 (Detectable Substrate) Composition + ++ ++++ − − − # 2 (Detectable substrate & serine beta- lactamase inhibitor)Composition + + + − + +/− − # 3 (Detectable substrate & AmpC inhibitor)Composition + + − − − − − # 4 (Detectable substrate, serine beta-lactamase inhibitor & AmpC inhibitor) Composition + − − − − − − # 5(Detectable substrate, metal chelator, serine beta- lactamase inhibitor& AmpC inhibitor) Composition +/− +/− +/− +/− − + − # 6 (Detectablesubstrate & ESBL inhibitor) AmpC* refers to plasmid-mediated AmpC orinducible chromosomal AmpC beta-lactamase. + and ++ indicate substrateutilization. +/− indicates the substrate may or may not be utilized in aparticular reaction. − indicates that the substrate is not utilized.

In one embodiment, a method for detecting the presence of a serinecarbapenemase or a metallo-beta-lactamase, comprises: (a) contacting:(i) a first bacterial sample with a first composition comprising adetectable beta-lactamase substrate and an AmpC inhibitor, and (ii) asecond bacterial sample with a second composition comprising adetectable beta-lactamase substrate, an AmpC inhibitor, and a serinebeta-lactamase inhibitor in an amount sufficient to inhibit anextended-spectrum beta-lactamase (ESBL) and an original-spectrumbeta-lactamase (OSBL) but not a class A serine carbapenemase, whereinthe first and second bacterial samples are from the same source; and (b)detecting utilization of the substrate in the first composition and thesecond composition, such that a class A serine carbapenemase or ametallo-beta-lactamase is detected if the substrate has been utilized inthe first and second compositions. To differentiate between the presenceof a serine carbapenemase and a metallo-beta-lactamase, a thirdbacterial sample from the same source as the first and second bacterialsamples can be contacted with a third composition comprising adetectable beta-lactamase substrate, an AmpC inhibitor, a serinebeta-lactamase inhibitor in an amount sufficient to inhibit an ESBL andan OSBL but not a class A serine carbapenemase, and a metal chelator,and the utilization of the substrate in the third composition isdetected. If substrate utilization in the third composition as well asin the first and second compositions is detected, then the presence of aclass A serine carbapenemase is detected in the bacterial source. If, onthe other hand, there is no substrate utilization detected in thirdcomposition but there is substrate utilization detected in the first andsecond compositions, then the presence of a metallo-beta-lactamase isdetected in the bacterial source. In addition, if no substrateutilization is detected in the third composition but substrateutilization in the first and second compositions is detected, then thepresence of a class A serine carbapenemase can be excluded. Table 2,below, summarizes results when a bacterial sample containing a class Aserine carbapenemase or a metallo-beta-lactamase is contacted with thecompositions described in this paragraph.

TABLE 2 Composition Substrate Utilization Detectable substrate + + &AmpC inhibitor Detectable substrate, + + AmpC inhibitor & serinebeta-lactamase inhibitor Detectable substrate, + − AmpC inhibitor,serine beta-lactamase inhibitor & metal chelator Indicates the Indicatesthe presence presence of a of a metallo-beta- class A serine lactamase &excludes the carbapenemase presence of a class A serine carbapenemaseAmpC refers to plasmid-mediated AmpC or inducible chromosomal AmpC.beta-lactamase + indicates substrate utilization. − indicates that thesubstrate is not utilized.

In a specific embodiment, a method for detecting the presence of abeta-lactamase, comprises: (a) contacting: (i) a first bacterial samplewith a first composition comprising a chromogenic beta-lactamasesubstrate and an AmpC inhibitor, and (ii) a second bacterial sample witha second composition comprising a chromogenic beta-lactamase substrate,an AmpC inhibitor, and a serine beta-lactamase inhibitor in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase, wherein the first and second bacterial samples are fromthe same source; and (b) detecting the color of the first compositionand the second composition, such that a beta-lactamase is detected ifthe color of the first and second compositions has changed in a mannerindicating substrate utilization, wherein the beta-lactamase is a classA serine carbapenemase or a metallo-beta-lactamase. In one embodiment,the AmpC inhibitor is cloxacillin. In another embodiment, the serinebeta-lactamase inhibitor is clavulanic acid. The first and secondcompositions, described in the preceding embodiments may be usedindependently or together in various combinations as one of skill in theart would appreciate. In another embodiment, the chromogenicbeta-lactamase substrate is nitrocefin. In a specific embodiment, thefirst composition comprises 20 μM to 200 μM of nitrocefin, 20 μM to 5 mMof cloxacillin, and 0.05 M to 1 M phosphate, or MES buffer. In anotherembodiment, the second composition comprises 20 μM to 200 μM ofnitrocefin, 20 μM to 5 mM of cloxacillin, 1 μM to 1.5 mM clavulanicacid, and 0.05 M to 1 M phosphate or MES buffer. In another embodiment,each composition is pH 5 to pH 7. In a specific embodiment, theconcentration of inhibitor used in a composition is dependent on theconcentration of beta-lactamase substrate in the composition.

In another specific embodiment, a method for detecting the presence of abeta-lactamase, comprises: (a) contacting: (i) a first bacterial samplewith a first composition comprising a chromogenic beta-lactamasesubstrate and an AmpC inhibitor, (ii) a second bacterial sample with asecond composition comprising a chromogenic beta-lactamase substrate, anAmpC inhibitor, and a serine beta-lactamase inhibitor in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase, and (iii) a third bacterial sample with a thirdcomposition comprising a chromogenic beta-lactamase substrate, an AmpCinhibitor, a serine beta-lactamase inhibitor in an amount sufficient toinhibit an ESBL and an OSBL but not a class A serine carbapenemase, anda metal chelator, wherein the first, second and third bacterial samplesare from the same source; and (h) detecting the color of the firstcomposition, the second composition, and the third composition, suchthat: (i) a beta-lactamase that is a class A serine carbapenemase isdetected if the color of the first composition, the second compositionand the third composition has changed in a manner indicating substrateutilization, and (ii) a beta-lactamase that is a metallo-beta-lactamaseis detected if the color of the first composition and the secondcomposition has changed in a manner indicating substrate utilization butthe color of the third composition has not changed in a mannerindicating substrate utilization. In one embodiment, the AmpC inhibitoris cloxacillin. In another embodiment, the serine beta-lactamaseinhibitor is clavulanic acid. In another embodiment, the metal chelatoris dipicolinic acid or diethyldithiocarbamate. In another embodiment,the chromogenic beta-lactamase substrate is nitrocefin. In a specificembodiment, the first composition comprises 20 μM to 200 μM ofnitrocefin, 20 μM to 5 mM of cloxacillin, and 0.05 M to 1 M phosphate,or MES buffer. In another embodiment, the second composition comprises20 μM to 200 μM of nitrocefin, 20 μM to 5 mM of cloxacillin, 0.1 μM to1.5 mM of clavulanic acid, and 0.05 M to 1 M phosphate, or MES buffer.In another embodiment, the third composition comprises 20 μM to 200 μMof nitrocefin, 20 μM to 5 mM of cloxacillin, 0.1 μM to 1.5 mM ofclavulanic acid, 0.5 mM to 1.5 mM of dipicolinic acid (DPC) or 1 mM to20 mM diethyldithiocarbamate (DEDTC) and 0.05 M to 1 M phosphate, or MESbuffer. The first, second and third compositions described in thepreceding embodiments may be used independently or together in variouscombinations as one of skill in the art will appreciate. In anotherembodiment, each composition is pH 5 to pH 7. In a specific embodiment,the concentration of inhibitor used in a composition is dependent on theconcentration of beta-lactamase substrate in the composition.

In another embodiment, presented herein is a method for detecting abeta-lactamase, comprising: (a) contacting: (i) a first bacterial samplewith a first composition comprising a detectable beta-lactamasesubstrate, and (ii) a second bacterial sample with a second compositioncomprising a detectable beta-lactamase substrate and a metal chelator,wherein the first and second bacterial samples are from the same source;and (b) detecting utilization of the substrate in the first compositionand the second composition such that: (i) a beta-lactamase other than ametallo-beta-lactamase is detected if the substrate in the firstcomposition and the second composition has been utilized, and (ii) abeta-lactamase that is a metallo-beta-lactamase is detected if thesubstrate in the first composition has been utilized but the substratein the second composition has not been utilized. In addition, thefailure to detect substrate utilization by the first composition and thesecond composition indicates that there is no beta-lactamase present inthe bacterial source. Table 3, below, summarizes results when abacterial sample containing a metallo-beta-lactamase or a beta-lactamaseother than a metal-beta-lactamase is contacted with the compositionsdescribed in this paragraph.

TABLE 3 Composition Substrate Utilization Detectable beta-lactamase + +substrate Detectable beta-lactamase + − substrate & metal chelatorIndicates the presence Indicates the of a beta-lactamase presence aother than a metallo- metallo-beta- beta-lactamase lactamase

In another specific embodiment, a method for detecting the presence of abeta-lactamase, comprises: (a) contacting: (i) a first bacterial samplewith a first composition comprising a chromogenic beta-lactamasesubstrate, and (ii) a second bacterial sample with a second compositioncomprising a chromogenic beta-lactamase substrate and a metal chelator,wherein the first and second samples are from the same source; and (b)detecting the color of the first composition and the second composition,such that: (i) a beta-lactamase other than a metallo-beta-lactamase isdetected if the color of the first composition and the secondcomposition has changed in a manner indicating substrate utilization,and (ii) a beta-lactamase that is a metallo-beta-lactamase is detectedif the color of the first composition has changed in a manner indicatingsubstrate utilization but the color of the second composition has notchanged in a manner indicating substrate utilization. In one embodiment,the chromogenic beta-lactamase substrate is nitrocefin. In anotherembodiment, the metal chelator is dipicolinic acid (DPC) ordiethyldithiocarbamate (DEDTC). In a specific embodiment, the firstcomposition comprises 20 μM to 200 μM of nitrocefin and 0.05 M to 1 Mphosphate or MES buffer. In another embodiment, the second compositioncomprises 20 μM to 200 μM of nitrocefin and 0.5 mM to 10 mM ofdipicolinic acid (DPC) or 1 mM to 20 mM diethyldithiocarbamate (DEDTC)and 0.05 M to 1 M phosphate or MES buffer. The first and secondcompositions, described in the preceding embodiments may be usedindependently or together in various combinations as one of skill in theart would appreciate. In another embodiment, each composition is pH 5 topH 7. In a specific embodiment, the concentration of inhibitor used in acomposition is dependent on the concentration of beta-lactamasesubstrate in the composition.

In another embodiment, a method for detecting a beta-lactamase,comprises: (a) contacting: (i) a first bacterial sample with a firstcomposition comprising a detectable beta-lactamase substrate and an AmpCinhibitor, (ii) a second bacterial sample with a second compositioncomprising a detectable beta-lactamase substrate, an AmpC inhibitor, anda serine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, (iii) a thirdbacterial sample with a third composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase, and a metal chelator, and (iv) a fourthbacterial sample with a fourth composition comprising a detectablebeta-lactamase substrate and a serine beta-lactamase inhibitor in anamount sufficient to inhibit an ESBL and an OSBL but not a class Aserine carbapenemase, wherein the first, second, third and fourthbacterial samples are from the same source; and (b) detectingutilization of the substrate in the first composition, the secondcomposition, the third composition, and the fourth composition suchthat: (i) a beta-lactamase that is a class A serine carbapenemase isdetected if the substrate in the first composition, the secondcomposition, the third composition and the fourth composition has beenutilized; (ii) a beta-lactamase that is a metallo-beta-lactamase isdetected if the substrate in the first composition, the secondcomposition, and the fourth composition has been utilized but thesubstrate in the third composition has not been utilized, and (iii) abeta-lactamase that is an AmpC beta-lactamase is detected if thesubstrate in the fourth composition has been utilized but the substratein the first composition, the second composition, and the thirdcomposition has not been utilized. In addition, the detection ofsubstrate utilization in the first, second and fourth compositions butthe failure to detect substrate utilization in the third compositionindicates that a class A serine carbapenemase is not present in thebacterial source. Further, the detection of substrate utilization in thefourth composition but the failure to detect substrate utilization inthe first, second and third compositions indicates that a class A serinecarbapenemase, a metallo-beta-lactamase and an ESBL are not present inthe bacterial source. Table 4, below, summarizes results when abacterial sample containing a class A serine carbapenemase, ametallo-beta-lactamase or an AmpC beta-lactamase is contacted with thecompositions described in this paragraph.

TABLE 4 Composition Substrate Utilization Detectable substrate & + ++ −AmpC inhibitor Detectable substrate, + + − AmpC inhibitor & serinebeta-lactamase inhibitor Detectable substrate, + − − AmpC inhibitor,serine beta-lactamase inhibitor & metal chelator Detectablesubstrate + + + & serine beta- lactamase inhibitor Indicates thepresence Indicates the presence of Indicates the presence of of a classA serine metallo-beta-lactamase & an AmpC & excludes the carbapenemaseexcludes the presence of a presence of a class A serine class A serinecarbapenemase carbapenemase & a metallo- beta-lactamase & ESBL AmpCrefers to plasmid-mediated AmpC or inducible chromosomal AmpCbeta-lactamase. + indicates substrate utilization. − indicates that thesubstrate is not utilized.

In a specific embodiment, a method for detecting a beta-lactamase,comprises: (a) contacting: (i) a first bacterial sample with a firstcomposition comprising a chromogenic beta-lactamase substrate and anAmpC inhibitor, (ii) a second bacterial sample with a second compositioncomprising chromogenic beta-lactamase substrate, an AmpC inhibitor, anda serine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, (iii) a thirdbacterial sample with a third composition comprising a chromogenicbeta-lactamase substrate, an AmpC inhibitor, a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase, and a metal chelator, and (iv) a fourthbacterial sample with a fourth composition comprising a chromogenicbeta-lactamase substrate and a serine beta-lactamase inhibitor in anamount sufficient to inhibit an ESBL and an OSBL but not a class Aserine carbapenemase, wherein the first, second, third and fourthbacterial samples are from the same source; and (b) detecting the colorof the first composition, the second composition, the third composition,and the fourth composition such that: (i) a beta-lactamase that is aclass A serine carbapenemase is detected if the color of the firstcomposition, the second composition, the third composition and thefourth composition has changed in a manner indicating substrateutilization; (ii) a beta-lactamase that is a metallo-beta-lactamase isdetected if the color of the first composition, the second composition,and the fourth composition has changed in a manner indicating substrateutilization but the color of the third composition has not changed in amanner indicating substrate utilization, and (iii) a beta-lactamase thatis an AmpC beta-lactamase is detected if the color of the fourthcomposition has changed in a manner indicating substrate utilization butthe color of the first composition, the second composition, and thethird composition has not changed in a manner indicating substrateutilization. In one embodiment, the AmpC inhibitor is cloxacillin. Inanother embodiment, the serine beta-lactamase inhibitor is clavulanicacid. In another embodiment, the metal chelator is DPC or DEDTC. Inanother embodiment, the chromogenic substrate is nitrocefin. In aspecific embodiment, the first composition comprises 20 μM to 200 μM ofnitrocefin, 20 μM to 5 mM of cloxacillin, and 0.05 M to 1 M phosphate orMES buffer. In another embodiment, the second composition comprises 20μM to 200 μM of nitrocefin, 20 μM to 5 mM of cloxacillin, 1 μM to 1.5 mMof clavulanic acid, and 0.05 M to 1 M phosphate or MES buffer. Inanother embodiment, the third composition comprises 20 μM to 200 μM ofnitrocefin, 20 μM to 5 mM of cloxacillin, 1 μM to 1.5 mM of clavulanicacid, 0.5 mM to 10 mM of DPC or 1 mM to 20 mM DEDTC and 0.05 M to 1 Mphosphate or MES in buffer. In another embodiment, the fourthcomposition comprises 20 μM to 200 μM of nitrocefin, 1 μM to 1.5 mM ofclavulanic acid and 0.05 M to 1 M phosphate or MES buffer. The first,second, third and fourth compositions described in the precedingembodiments may be used independently or together in variouscombinations as one of skill in the art will appreciate. In anotherembodiment, each composition is pH 5 to pH 7. In a specific embodiment,the concentration of inhibitor used in a composition is dependent on theconcentration of beta-lactamase substrate in the composition.

In another embodiment, a method for detecting the presence of abeta-lactamase, comprises: (a) contacting: (i) a first bacterial samplewith a first composition comprising a detectable beta-lactamasesubstrate and an AmpC inhibitor, (ii) a second bacterial sample with asecond composition comprising a detectable beta-lactamase substrate, anAmpC inhibitor, and a serine beta-lactamase inhibitor in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase, (iii) a third bacterial sample with a third compositioncomprising a detectable beta-lactamase substrate, an AmpC inhibitor, aserine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, and a metalchelator, (iv) a fourth bacterial sample with a fourth compositioncomprising a detectable beta-lactamase substrate and a serinebeta-lactamase inhibitor in an amount sufficient to inhibit an ESBL andan OSBL but not a class A serine carbapenemase, and (v) a fifthbacterial sample with a fifth composition comprising a detectablebeta-lactamase substrate and an ESBL inhibitor, wherein the first,second, third, fourth and fifth bacterial samples are from the samesource; and (b) detecting utilization of the substrate in the firstcomposition, the second composition, the third composition, the fourthcomposition, and fifth composition such that: (i) a beta-lactamase thatis an ESBL is detected if the substrate in the first composition hasbeen utilized but the substrate the second composition, the thirdcomposition, the fourth composition, and the fifth composition has notbeen utilized, (ii) a beta-lactamase that is an AmpC beta-lactamase isdetected if the substrate in the fourth composition has been utilizedbut the substrate in the first composition, the second composition andthe third composition has not been utilized, (iii) a beta-lactamase thatis a metallo-beta-lactamase is detected if the substrate in the firstcomposition, the second composition, and the fourth composition has beenutilized but the substrate in the third composition has not beenutilized, and (iv) a beta-lactamase that is a class A serinecarbapenemase is detected if the substrate in the first composition, thesecond composition, the third composition, and the fourth compositionhas been utilized. In addition, the detection of substrate utilizationin first composition but the failure to detect substrate utilization inthe second, third, fourth and fifth compositions indicates that a classA serine carbapenemase, a metallo-beta-lactamase, and an AmpCbeta-lactamase are not present in the sample. In addition, the detectionof substrate utilization in the first, second and fourth compositionsbut the failure to detect substrate utilization in the third compositionindicates that a class A serine carbapenemase is not present in thebacterial source. Further, the detection of substrate utilization in thefourth composition but the failure to detect substrate utilization inthe first, second and third compositions indicates that a class A serinecarbapenemase, a metallo-beta-lactamase and an ESBL are not present inthe bacterial source. Table 5, below, summarizes results when abacterial sample containing a serine carbapenemase, ametallo-beta-lactamase, an AmpC or an ESBL is contacted with thecompositions described in this paragraph.

In another embodiment, a method for detecting the presence of abeta-lactamase, comprises: (a) contacting: (i) a first bacterial samplewith a first composition comprising a chromogenic beta-lactamasesubstrate and an AmpC inhibitor, (ii) a second bacterial sample with asecond composition comprising a chromogenic beta-lactamase substrate, anAmpC inhibitor, and a serine beta-lactamase inhibitor in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase, (iii) a third bacterial sample with a third compositioncomprising a chromogenic beta-lactamase substrate, an AmpC inhibitor, aserine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, and a metalchelator, (iv) a fourth bacterial sample with a fourth compositioncomprising a chromogenic beta-lactamase substrate and a serinebeta-lactamase inhibitor in an amount sufficient to inhibit an ESBL andan OSBL but not a class A serine carbapenemase, and (v) a fifthbacterial sample with a fifth composition comprising a chromogenicbeta-lactamase substrate and an ESBL inhibitor, wherein the first,second, third, fourth and fifth bacterial samples are from the samesource; and (b) detecting the color of the first composition, the secondcomposition, the third composition, the fourth composition, and fifthcomposition such that: (i) a beta-lactamase that is an ESBL is detectedif the color of the first composition has changed in a manner indicatingsubstrate utilization but the color of the second composition, the thirdcomposition, the fourth composition, and the fifth composition has notchanged in a manner indicating substrate utilization, (ii) abeta-lactamase that is an AmpC beta-lactamase is detected if the colorof the fourth composition has changed in a manner indicating substrateutilization but the color of the first composition, the secondcomposition and the third composition has not changed in a mannerindicating substrate utilization, (iii) a beta-lactamase that is ametallo-beta-lactamase is detected if the color of the firstcomposition, the second composition, and the fourth composition haschanged in a manner indicating substrate utilization but the color ofthe third composition has not changed in a manner indicating substrateutilization, and (iv) a beta-lactamase that is a class A serinecarbapenemase is detected if the color of the first composition, thesecond composition, the third composition, and the fourth compositionhas changed in a manner indicating substrate utilization. In oneembodiment, the AmpC inhibitor is cloxacillin. In another embodiment,the serine beta-lactamase inhibitor is clavulanic acid. In anotherembodiment, the metal chelator is DEDTC or DPC. In another embodiment,the ESBL inhibitor is cefotaxime or ceftazidime. In another embodiment,the chromogenic substrate is nitrocefin. In a specific embodiment, thefirst composition comprises 20 μM to 200 μM of nitrocefin, 20 μM to 5 mMof cloxacillin, and 0.05 M to 1 M phosphate or MES buffer. In anotherembodiment, the second composition comprises 20 μM to 200 μM ofnitrocefin, 20 μM to 5 mM of cloxacillin, 0.5 mM to 1.5 mM of clavulanicacid, and 0.05 M to 1 M phosphate or MES buffer. In another embodiment,the third composition comprises 20 μM to 200 μM of nitrocefin, 20 μM to5 mM of cloxacillin, 0.1 μM to 1.5 mM of clavulanic acid, 0.5 mM to 10mM of DPC or 1 mM to 20 mM DEDTC and 0.05 M to 1 M phosphate or MESbuffer. In another embodiment, the fourth composition comprises 20 μM to200 μM of nitrocefin, 0.1 μM to 1.5 mM of clavulanic acid and 0.05 M to1 M phosphate or MES buffer. In another embodiment, the fifthcomposition comprises 20 μM to 200 μM of nitrocefin, 1 mM to 10 mM ofcefotaxime or ceftazidime and 0.05 M to 1 M phosphate or MES buffer. Thefirst, second, third, fourth and fifth compositions described in thepreceding embodiments may be used independently or together in variouscombinations as one of skill in the art will appreciate. In anotherembodiment, each composition is pH 5 to pH 7. In a specific embodiment,the concentration of inhibitor used in a composition is dependent on theconcentration of beta-lactamase substrate in the composition.

TABLE 5 Composition Substrate Utilization Detectable substrate & + + − +AmpC inhibitor Detectable substrate, + + − − AmpC inhibitor and serinebeta-lactamase inhibitor Detectable substrate, + − − − AmpC inhibitor,serine beta-lactamase inhibitor & a metal chelator Detectablesubstrate + + − − & serine beta- lactamase inhibitor Detectablesubstrate & +/− +/− +/− − ESBL inhibitor Indicates the presenceIndicates the presence of Indicates the presence of Indicates thepresence of of a class A serine a metallo-beta-lactamase & an AmpC &excludes the ESBL & excludes the carbapenemase excludes the presence ofa presence of a class A serine presence of a class A serine class Aserine carbapenemase carbapenemase, a metallo- carbapenemase, a metallo-beta-lactamase & ESBL beta-lactamase and an AmpC AmpC refers toplasmid-mediated AmpC or inducible chromosomal AmpC beta-lactamase. +indicates substrate utilization. +/− indicates the substrate may or maynot be utilized in a particular reaction. − indicates that the substrateis not utilized.

In another embodiment, a method for detecting the presence of abeta-lactamase(s), comprises: (a) contacting: (i) a first bacterialsample with a first composition comprising a detectable beta-lactamasesubstrate and an AmpC inhibitor, (ii) a second bacterial sample with asecond composition comprising a detectable beta-lactamase substrate anda serine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, and (iii) athird bacterial sample with a third composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase, wherein the first, second and third,bacterial samples are from the same source; and (b) detectingutilization of the substrate in the first composition, the secondcomposition, and the third composition such that: (i) beta-lactamasesthat are an AmpC and an ESBL or that is an AmpC and OSBL is detected ifthe substrate in the first composition and second composition has beenutilized but the substrate in the third composition has not beenutilized, (ii) a beta-lactamase that is an AmpC is detected if thesubstrate in the second composition has been utilized but the substratein the first composition and the third composition has not beenutilized, and (iii) a beta-lactamase that is an ESBL and/or OSBL isdetected if the substrate in the first composition has been utilized butthe substrate in the second composition and the third composition hasnot been utilized. In addition, the detection of substrate utilizationin the second composition but the failure to detect substrateutilization in the first and third compositions indicates that an ESBLand/or an OSBL are not present in the bacterial source. Table 6, below,summarizes results when a bacterial sample containing an AmpC, an ESBLand/or an OSBL is contacted with the compositions described in thisparagraph.

TABLE 6 Composition Substrate Utilization Detectable substrate & + − +AmpC inhibitor Detectable substrate + + − & serine beta- lactamaseinhibitor Detectable substrate, − − − AmpC inhibitor & serinebeta-lactamase inhibitor Indicates the Indicates the Indicates thepresence of presence of an AmpC & presence of an AmpC + ESBL excludesthe presence ESBL &/or OSBL or AmpC + OSBL of ESBL &/or OSBL AmpC meansplasmid-mediated AmpC or inducible chromosomal AmpC.

In another embodiment, a method for detecting the presence of abeta-lactamase, comprises: (a) contacting: (i) a first bacterial samplewith a first composition comprising a chromogenic beta-lactamasesubstrate and an AmpC inhibitor, (ii) a second bacterial sample with asecond composition comprising a chromogenic beta-lactamase substrate anda serine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase, and (iii) athird bacterial sample with a third composition comprising a chromogenicbeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase, wherein the first, second and thirdbacterial samples are from the same source; and (b) detecting the colorof the first composition, the second composition, and the thirdcomposition such that: (i) beta-lactamases that are an AmpC and an ESBLor an AmpC and OSBL is detected if the color of the first compositionand second composition has been changed in a manner indicating substrateutilization but the color of the third composition has not changed in amanner indicating substrate utilization, (ii) a beta-lactamase that isan AmpC is detected if the color of the second composition has changedin a manner indicating substrate utilization but the color of the firstcomposition and the third composition has not changed in a mannerindicating substrate utilization, and (iii) a beta-lactamase that is anESBL and/or OSBL is detected if the color of the first composition haschanged in a manner indicating substrate utilization but the color ofthe second composition and the third composition has not changed in amanner indicating substrate utilization. In one embodiment, the AmpCinhibitor is cloxacillin. In another embodiment, the serinebeta-lactamase inhibitor is clavulanic acid. In another embodiment, thechromogenic substrate is nitrocefin. In a specific embodiment, the firstcomposition comprises 20 μM to 200 μM of nitrocefin, 20 μM to 5 mM ofcloxacillin, and 0.05 M to 1 M phosphate or MES buffer. In anotherembodiment, the second composition comprises 20 μM to 200 μM ofnitrocefin, 1 μM to 1.5 mM of clavulanic acid, and 0.05 M to 1 Mphosphate or MES buffer. In another embodiment, the third compositioncomprises 20 μM to 200 μM of nitrocefin, 20 μM to 5 mM of cloxacillin, 1μM to 1.5 mM of clavulanic acid, and 0.05 M to 1 M phosphate or MESbuffer. In another embodiment, each composition is pH 5 to pH 7. Inanother embodiment, the fourth composition comprises 20 μM to 200 μM ofnitrocefin, 1 μM to 1.5 mM of clavulanic acid and 0.05 M to 1 Mphosphate or MES buffer. The first, second and third compositionsdescribed in the preceding embodiments may be used independently ortogether as one of skill in the art will appreciate. In anotherembodiment, each composition is pH 5 to pH 7. In a specific embodiment,the concentration of inhibitor used in a composition is dependent on theconcentration of beta-lactamase substrate in the composition.

In certain embodiments, the compositions used in accordance with themethods described herein comprise a lysis reagent. Lysis reagents (e.g.,a lysis reagent in a lysis buffer) are known to one of skill in the art.In a specific embodiment, the lysis reagent lyses the bacterial cellsbut does not interfere with either the hydrolysis of the beta-lactamasesubstrate or the activity of one or more beta-lactamase inhibitors, orboth. In one embodiment, the lysis reagent is a detergent, such as amild non-denaturing detergent (e.g., Triton® X-100 or CHAPS). In anotherembodiment, the lysis reagent is an enzyme or other agent that promotesthe lysis of a bacterial cell. Non-limiting examples of such an enzymeinclude lysozyme, labiase, lysostaphin, achromopeptidase, andmutanolysin. In a particular embodiment, the compositions used inaccordance with the methods described herein comprise about 0.1 mg/ml toabout 10 mg/ml, about 0.5 mg/ml to about 10 mg/ml, about 1 mg/ml toabout 10 mg/ml, about 2 mg/ml to about 10 mg/ml, about 3 mg/ml to about10 mg/ml, about 4 mg/ml to about 10 mg/ml or about 5 mg/ml to about 10mg/ml of an enzyme or other agent that promotes the lysis of a bacterialcell. In another embodiment, the compositions used in accordance withthe methods described herein comprise about 0.1 mg/ml to about 8 mg/ml,about 1 mg/ml to about 6 mg/ml, about 1 mg/ml to about 5 mg/ml, about 1mg/ml to about 5 mg/ml, about 2 mg/ml to 4 mg/ml, or about 3 mg/ml of anenzyme or other agent that promotes the lysis of a bacterial cell.

In a specific embodiment, the compositions used in accordance with themethods described herein comprise lysozyme. In a particular embodiment,the compositions used in accordance with the methods described hereincomprise about 0.1 mg/ml to about 10 mg/ml, about 0.5 mg/ml to about 10mg/ml, about 1 mg/ml to about 10 mg/ml, about 2 mg/ml to about 10 mg/ml,about 3 mg/ml to about 10 mg/ml, about 4 mg/ml to about 10 mg/ml orabout 5 mg/ml to about 10 mg/ml of lysozyme. In another embodiment, thecompositions used in accordance with the methods described hereincomprise about 0.1 mg/ml to about 8 mg/ml, about 1 mg/ml to about 6mg/ml, about 1 mg/ml to about 5 mg/ml, about 1 mg/ml to about 5 mg/ml,about 2 mg/ml to 4 mg/ml, or about 3 mg/ml of lysozyme.

In certain embodiments, the compositions used in accordance with themethods described herein comprise a lysis reagent (e.g., lysozyme,labiase, lysostaphin, achromopeptidase, or mutanolysin) and an agentthat promotes the stabilization of the lysis reagent. In a specificembodiment, the agent that promotes the stabilization of the lysisreagent does not interfere with either the hydrolysis of thebeta-lactamase substrate or the activity of one or more beta-lactamaseinhibitors, or both. In one embodiment, the agent that promotes thestabilization of the lysis reagent is thermal stable. In a specificembodiment, the agent that promotes the stabilization of the lysisreagent is stable at temperatures of about 60° C. or higher, about 50°C. to about 100° C., about 60° C. to about 90° C., about 60° C. to about85° C., about 60° C. to about 75° C., or about 60° C. to about 70° C. Ina particular embodiment, the compositions used in accordance with themethods described herein comprise about 0.1% to about 10%, about 1% toabout 10%, about 2% to about 10%, about 4% to about 10%, about 1% toabout 8%, about 2% to about 8%, about 2% to about 6%, or about 2% toabout 4% of an agent that promotes the stabilization of the lysisreagent.

In a specific embodiment, the compositions used in accordance with themethods described herein comprise a lysis reagent and a carbohydrate,e.g., a monosaccharide, a disaccharide, a polysaccharide, anoligosaccharide, or a polyol. Specific examples of carbohydratesinclude, but are not limited to mannitol, ribose, glucose, fructose,mannose, sucrose, lactose, glycerol, Xanthan gum, trehalose and glycols(e.g. propylene glycol). In a specific embodiment, the carbohydrate istrehalose.

In a specific embodiment, the compositions used in accordance with themethods described herein comprise lysozyme and trehalose. In aparticular embodiment, the compositions used in accordance with themethods described herein comprise about 0.1 mg/ml to about 10 mg/ml,about 0.5 mg/ml to about 10 mg/ml, about 1 mg/ml to about 10 mg/ml,about 2 mg/ml to about 10 mg/ml, about 3 mg/ml to about 10 mg/ml, about4 mg/ml to about 10 mg/ml or about 5 mg/ml to about 10 mg/ml of lysozymeand about 0.1% to about 10%, about 1% to about 10%, about 2% to about10%, about 4% to about 10%, about 1% to about 8%, about 2% to about 8%,about 2% to about 6%, or about 2% to about 4% of trehalose. In anotherembodiment, the compositions used in accordance with the methodsdescribed herein comprise about 0.1 mg/ml to about 8 mg/ml, about 1mg/ml to about 6 mg/ml, about 1 mg/ml to about 5 mg/ml, about 1 mg/ml toabout 5 mg/ml, about 2 mg/ml to 4 mg/ml, or about 3 mg/ml of lysozymeand about 0.1% to about 10%, about 1% to about 10%, about 2% to about10%, about 4% to about 10%, about 1% to about 8%, about 2% to about 8%,about 2% to about 6%, or about 2% to about 4% of trehalose.

In certain embodiments, the compositions used in accordance with themethods described herein comprise a lysis reagent (e.g., lysozyme,labiase, lysostaphin, achromopeptidase, or mutanolysin) and anadditional agent, e.g., an agent that enhances the lysis of a bacterialcell by a lysis reagent (e.g., a metal chelator). In certainembodiments, the compositions used in accordance with the methodsdescribed herein comprise a lysis reagent (e.g., lysozyme, labiase,lysostaphin, achromopeptidase, or mutanolysin), an agent that promotesthe stabilization of the lysis reagent, and an additional agent, e.g.,an agent that enhances the lysis of a bacterial cell by a lysis reagent(e.g., a metal chelator). In a specific embodiment, the agent thatpromotes the stabilization of the lysis reagent does not interfere witheither the hydrolysis of the beta-lactamase substrate or the activity ofone or more beta-lactamase inhibitors, or both. In specific embodiments,an agent that enhances the lysis of a bacterial cell by a lysis reagentincreases rate at which the lysis reagent lyses bacterial cells by about10%, about 20%, about 25%, about 30%, about 40%, about 50%, about 60% orabout 75% relative the rate at which the lysis reagent lyses bacterialcells in the absence of the agent. In other embodiments, an agent thatenhances the lysis of a bacterial cell by a lysis reagent increases rateat which the lysis reagent lyses bacterial cells by about 10% to about50%, about 10% to about 75%, about 25% to about 75%, about 25% to about50%, about 25% to about 40%, about 25% to about 30% or about 50% orabout 75% relative the rate at which the lysis reagent lyses bacterialcells in the absence of the agent. In certain embodiments, thecompositions used in accordance with the methods described hereincomprise about 0.1 mM to about 5 mM, about 1 mM to about 4 mM, about 1mM to about 3 mM, about 2 mM to about 3 mM, or about 0.1 to about 2 mMof an agent that enhances the lysis of a bacterial cell by a lysisreagent.

In a specific embodiment, the compositions used in accordance with themethods described herein comprise a lysis reagent, an agent thatpromotes the stabilization of the lysis reagent, and EDTA or EGTA. Inparticular embodiments, either EDTA or EGTA, or both are not utilized ifa metallo-beta-lactamase is or may be detected.

In a specific embodiment, the compositions used in accordance with themethods described herein comprise a lysozyme, trehalose and EDTA. In aparticular embodiment, the compositions used in accordance with themethods described herein comprise about 0.1 mg/ml to about 10 mg/ml,about 0.5 mg/ml to about 10 mg/ml, about 1 mg/ml to about 10 mg/ml,about 2 mg/ml to about 10 mg/ml, about 3 mg/ml to about 10 mg/ml, about4 mg/ml to about 10 mg/ml or about 5 mg/ml to about 10 mg/ml oflysozyme, about 0.1% to about 10%, about 1% to about 10%, about 2% toabout 10%, about 4% to about 10%, about 1% to about 8%, about 2% toabout 8%, about 2% to about 6%, or about 2% to about 4% of trehalose,and about 0.1 mM to about 5 mM, about 1 mM to about 4 mM, about 1 mM toabout 3 mM, about 2 mM to about 3 mM, or about 0.1 to about 2 mM ofEDTA. In another embodiment, the compositions used in accordance withthe methods described herein comprise about 0.1 mg/ml to about 8 mg/ml,about 1 mg/ml to about 6 mg/ml, about 1 mg/ml to about 5 mg/ml, about 1mg/ml to about 5 mg/ml, about 2 mg/ml to 4 mg/ml, or about 3 mg/ml oflysozyme, about 0.1% to about 10%, about 1% to about 10%, about 2% toabout 10%, about 4% to about 10%, about 1% to about 8%, about 2% toabout 8%, about 2% to about 6%, or about 2% to about 4% of trehalose,and about 0.1 mM to about 5 mM, about 1 mM to about 4 mM, about 1 mM toabout 3 mM, about 2 mM to about 3 mM, or about 0.1 to about 2 mM ofEDTA.

In some embodiments, the compositions used in accordance with themethods described herein are in the form of a liquid composition, anagar plate, a paper strip, a paper disk, a tablet, a dry form in wells,or a dry form in one or more tubes, e.g., an array of tubes. In someembodiments, the compositions used in accordance with the methodsdescribed herein are dried and are present on or in a solid support,such as the well of a plate, a panel, a cassette or a tray, a paperstrip, a paper disk, or a tube. As used herein, the term “solid support”in the context of the form of a composition described herein refers to asolid surface that a composition described herein may be dried oradhered to and is suitable for the detection of a beta-lactamase inaccordance with the methods presented herein. Non-limiting examples ofsolid supports include silica gels, resins, derivatized plastic films,glass beads, and polystyrene beads.

In certain embodiments, the compositions used in accordance with themethods described herein are dried onto or in a solid support using heatat temperatures of, e.g., 50° C. to 100° C., 50° C. to 85° C., 50° C. to75° C., 60° C. to 75° C. or 60° C. to 70° C. In one embodiment, thecompositions used in accordance described herein are dried onto or in asolid support using heat under forced air or vacuum conditions attemperatures of, e.g., 50° C. to 100° C., 50° C. to 85° C., 50° C. to75° C., 60° C. to 75° C. or 60° C. to 70° C. In other embodiments, thecompositions used in accordance with the methods described herein aredried onto or in a solid support using a lypholization technique. Inother embodiments, the compositions described herein are dried onto orin a solid support using a spray drying technique.

In certain embodiments, the compositions used in accordance with themethods described herein are pre-mixed and dried into the wells of apanel, tray, cassette or plate (e.g., a microtiter plate). In specificembodiments, the compositions used in accordance with the methodsdescribed herein are pre-mixed and dried into the wells of a tray, acassette, a microtiter plate or a panel, such as a well of the Phoenix™Panel (BD, USA), a well of a panel for the BBL™ Crystal™ IdentificationSystem (BD, USA), a Vitek® card (bioMerieux, USA), a well of a MicroScanpanel (Dade Behring, USA), or a well of a panel for the Remel RapID™System (Remel, USA). See, e.g., U.S. Pat. No. 5,922,593 and Des. 421,498(each of which are incorporated herein by reference) for a descriptionof panels with wells that the compositions described herein may be driedin or on using, e.g., heat at temperatures of, e.g., 50° C. to 100° C.,50° C. to 85° C., 50° C. to 75° C., 60° C. to 75° C. or 60° C. to 70° C.In other embodiments, the compositions used in accordance with themethods described herein are pre-mixed and dried into the tubes, e.g.,test tubes or Eppendorf tubes. In a specific embodiment, thecompositions used in accordance with the methods described herein arepre-mixed and dried into the tubes for the API biochemical test(bioMerieux, USA).

In a particular embodiment, the compositions used in the accordance withthe methods described herein are dried and are present in the wells of aPhoenix™ Panel (BD, USA) and an automated system, such as the BDPhoenix™ Automated Microbiology System (BD, USA), is used to detectsubstrate utilization. See, e.g., U.S. Pat. Nos. 5,922,593, 6,096,272,6,372,485 and 7,115,384 (each of which are incorporated herein byreference) for a description of an automated system for detection ofsubstrate utilization. In specific embodiments, a pure bacterial sampleresuspended in a saline buffer or broth (e.g., AST broth or ID broth(BD, USA)), is added to a Phoenix™ panel (BD. USA) with individual wellscomprising a composition described herein, the panel is incubated for aperiod of time in the BD Phoenix™ Automated Microbiology System (BD,USA) and substrate utilization is detect at different time points.

In another embodiment, the compositions used in accordance with themethods described herein are dried and present in the wells of a panelfor the BBL™ Crystal™ Identification System (BD, USA) and an automatedsystem, such as the BBL™ Crystal™ Identification System (BD, USA), isused to detect substrate utilization. In another embodiment, thecompositions used in the accordance with the methods described hereinare dried and are present in the wells of a Vitek® card (bioMerieux,USA) and an automated system, such as the Vitek® system (bioMerieux,USA), is used to detect substrate utilization. In another embodiment,the compositions used in the accordance with the methods describedherein are dried and are present in the wells of a MicroScan panel (DadeBehring, USA) and an automated system, such as the MicroScan Walk-Away®system (Dade Behring, USA), is used to detect substrate utilization.

In another embodiment, the compositions used in accordance with themethods described herein are in the form of a tablet. The tablet and abacterial cell suspension may be combined in any type of suitablecontainer (e.g., the wells of microtiter plate, a test tube or anEppendorf tube), and substrate utilization may be detected by anappropriate technique or device which will vary depending on thesubstrate chosen.

In another embodiment, the compositions used in accordance with themethods described herein are in the faint of a dry powder. The drypowder and a bacterial cell suspension may be combined in any type ofsuitable container (e.g., the wells of microtiter plate, a test tube oran Eppendorf tube), and substrate utilization may be detected by anappropriate technique or device which will vary depending on thesubstrate chosen.

Different compositions for use in detecting the presence of particularbeta-lactamases can be contacted with a bacterial sample from the samesource simultaneously or sequentially. In a specific embodiment,different compositions (e.g., a first composition and a secondcomposition) are contacted with a bacterial sample from the same sourcewithin about 1 minute to about 15 minutes, about 1 minute to about 10minutes, about 1 minute to about 5 minutes, about 2 seconds to about 60seconds, about 2 seconds to about 45 seconds, about 2 seconds to about30 seconds, about 5 second to about 60 seconds or about 5 second toabout 30 seconds of each other. In another embodiment, differentcompositions (e.g., a first composition and a second composition) arecontacted with a bacterial sample from the same source within about 15minutes, about 10 minutes, about 5 minutes, about 4 minutes, about 2minutes or about 1 minute of each other.

In some embodiments, in addition to a bacterial sample to be tested forthe presence of particular beta-lactamases, a bacterial sample that isknown to express one or more particular beta-lactamases (i.e., apositive control) is included in the methods presented herein. In otherembodiments, in addition to a bacterial sample to be tested for thepresence of particular beta-lactamases, a bacterial sample that is knownto not express one or more particular beta-lactamases (i.e., a negativecontrol) is included in the methods presented herein. In yet otherembodiments, in addition to a bacterial sample to be tested for thepresence of particular beta-lactamases, a bacterial sample that is knownto express one or more particular beta-lactamases (i.e., a positivecontrol) and a bacterial sample that is known to not express one or moreparticular beta-lactamases (i.e., a negative control) are included inthe methods presented herein. For example, a positive control for anAmpC beta-lactamase can be ATCC No. 700603 and a negative control can beATCC No. 25922. Positive and negative controls for the assays describedherein may be identified using molecular and/or biochemical methods,such as sequencing, to determine the expression of a particularbeta-lactamase by a particular bacterial strain.

Generally, the bacterial samples contacted with the differentcompositions utilized as part of the methods presented herein are fromthe same source. In some embodiments, a bacterial sample contacted witha composition in accordance with the methods presented herein is a purebacterial sample. In certain other embodiments, a bacterial samplecontacted with a composition in accordance with the methods presentedherein is a sample from a bacterial culture, which was inoculated with asample from a particular source, such as a patient specimen, andincubated for a period of time to allow the bacteria to proliferate. Inone embodiment, the bacterial sample contains at least the minimumamount of bacteria required to detect substrate utilization of adetectable beta-lactamase substrate. In a specific embodiment, abacterial sample comprises at least 10³ colony forming units (CFU)/ml,preferably at least 10⁵ CFU/ml, more preferably at least 10⁶, and mostpreferably at least 10⁷ CFU/ml of bacteria. In another embodiment, abacterial sample comprises about 10³ CFU/ml to about 10¹² CFU/ml, about10⁵ CFU/ml to about 10¹² CFU/ml, about 10⁶ CFU/ml to about 10¹² CFU/ml,or about 10⁷ CFU/ml to about 10¹² CFU/ml of bacteria. In a particularembodiment, a bacterial sample comprises about 10⁷ CFU/ml to about 10¹⁰CFU/ml of bacteria. In one embodiment, approximately the same number ofbacteria are in each bacterial sample contacted with each of thecompositions. In a specific embodiment, approximately the same amount ofCFU are contacted with each of the compositions.

In some embodiments, a bacterial sample is a sample of bacteria that isadded to a buffer, sterile water, saline or a broth (e.g., AST broth orID broth (BD, USA)) to make a cell suspension. In one embodiment, thesame amount of the cell suspension is contacted with each of thecompositions. In a specific embodiment, the turbidity of the cellsuspension contacted with each composition is within an acceptable rangefor the device utilized to detect substrate utilization. In anotherembodiment, the turbidity of the cell suspension contacted with each ofthe compositions is about 0.1 to about 3, about 0.2 to about 2.5 orabout 0.2 to about 2 as measured by a Dade Behring Microscan turbidityreader. In another embodiment, the turbidity of the cell suspensioncontacted with each of the compositions is about 0.1 to about 4, about0.2 to about 5, or about 0.25 to about 4 MacFarland as measured byPhoenixSpec. In another embodiment, the turbidity of the cell suspensioncontacted with each of the compositions is about 0.1 to about 5, about0.1 to about 4, about 0.2 to about 5, or about 0.25 to about 4MacFarland as measured by PhoenixSpec after being diluted about 5 to 10times. In another embodiment, the turbidity of the cell suspensioncontacted with each of the compositions is about 0.4 to about 0.8, about0.5 to about 0.7, or about 0.5 to about 0.6 MacFarland as measured byPhoenixSpec (BD, USA).

In a specific embodiment, the concentration of the same inhibitorpresent in more than one, two or more of the compositions is the same orsimilar (within about 10% of each other). In another, the concentrationof detectable beta-lactamase substrate is the same or similar (i.e.within about 10% of each other) in all of the compositions. In anotherembodiment, each composition utilized in any method presented herein isabout pH 5 to about pH 8, preferably about pH 5.5 to about pH 7.5, andmore preferably pH 6 to about pH 7. In a specific embodiment, eachcomposition has the same or a similar (i.e., within about 10% or about5% of each other) pH.

In a specific embodiment, the contacting step of the methods presentedherein is conducted at about 20° C. to about 42° C., more preferablyabout 25° C. to about 40° C., and most preferably about 37° C. Inanother embodiment, each of the compositions is contacted with abacterial sample from the same source in accordance with the methodspresented herein at the same or approximately the same (i.e., within 5°C.) temperature.

The detection step of the methods presented herein may be performed forthe minimum amount of time needed for enough substrate to be utilized bya bacterial sample positive for beta-lactamase to allow detection by astandard method for a particular detectable substrate (e.g., visualobservation and/or spectrophotometry for a chromogenic beta-lactamasesubstrate).

In a particular embodiment, the detection step of the methods presentedherein is performed about 2 minutes to about 60 minutes, preferablyabout 2 minutes to about 45 minutes or about 2 minutes to about 30minutes, more preferably about 2 minutes to about 15 minutes, and mostpreferably about 2 minutes to about 10 minutes after the contactingstep. In another embodiment, the detection step of the methods presentedherein is performed about 15 minutes to about 5 hours, about 30 minutesto about 5 hours, about 30 minutes to about 4 hours, about 30 minutes toabout 5 hours, about 1 hour to about 2 hours, about 1 hour to about 3hours, about 1 hour to about 4 hours, about 1 hour to about 5 hours,about 2 hours to about 4 hours, about 2 hours to about 5 hours, or about2 hours to about 6 hours after the contacting step. In anotherembodiment, the detection step of the methods presented herein isperformed at different time points over about 24 hours, about 20 hours,about 18 hours, about 16 hours, about 12 hours, about 8 hours, about 4hours, about 2 hours or about 1 hour. In a specific embodiment, thedetection step is performed after each bacterial sample from the samesource is contacted with each composition for the same amount of time.

In some embodiments, the rate of substrate utilization when bacterialsamples from the same source are contacted with different compositionsis compared. In a specific embodiment, a spectrophotometer that hassoftware to calculate the rate of substrate utilization is used. Theenzymatic activity of different beta-lactamases may be affecteddifferently by the concentration of detectable beta-lactamase substrateincluded in a composition, the concentration and type of inhibitorsincluded in a composition, the pH of the composition, and thetemperature at which the contacting step is conducted. For example, aserine carbapenemase can utilize a beta-lactamase substrate present in acomposition comprising cloxacillin at a similar rate as a beta-lactamasesubstrate present in a composition comprising cloxacillin and clavulanicacid. On the other hand, a metallo-beta-lactamase can utilize abeta-lactamase substrate faster than it can utilize a beta-lactamasesubstrate present in a composition comprising a beta-lactamase substrateand a metal chelator.

In some embodiments, a qualitative difference between the compositionsis compared when determining substrate utilization. For example, if achromogenic beta-lactamase substrate, such as nitrocefin, is used in thecompositions, whether or not the compositions turn a particular color(e.g., red for nitrocefin) may be assessed. In other embodiments, aquantitative difference between the compositions is compared whendetermining substrate utilization. For example, if nitrocefin, achromogenic beta-lactamase substrate, is used in the compositions, thepercentage of the substrate that turns red may be assessed.

The particular technique used to assess substrate utilization will varydepending upon the substrate chosen. For example, if the detectablebeta-lactamase substrate is a chromogenic substrate (e.g., nitrocefin orPADAC®), then substrate utilization can be assessed by visualobservation or spectrophotometry (at, e.g., a wavelength of 492 nm or390 nm for nitrocefin). In particular, the hydrolysis of nitrocefin canbe, for example, detected by visually observing the color of thesubstrate turning from yellow to red. The hydrolysis of PADAC® can bedetected by visually observing the color of the substrate turning fromviolet to yellow. If the detectable beta-lactamase substrate is afluorogenic substrate, then substrate utilization can be detected bymeasuring the fluorescence of the substrate. Different antibiotics havedifferent wavelengths and the use of an antibiotic as a substrate by abacterial species will result in a change in the wavelength of thecomposition. Thus, in some embodiments, a spectrophometer is used tomonitor changes in the wavelength of a composition comprising anantibiotic as the beta-lactamase substrate.

In specific embodiments, the BD Phoenix™ Automated Microbiology System(BD, USA) is used to assess substrate utilization. In other embodiments,the Vitek® 2 automated system (bioMerieux, USA) is used to assesssubstrate utilization. In other embodiments, the MicroScan Walk-Away®automated system (Dade Behring, USA) is used to assess substrateutilization.

4.2 Compositions for Use in the Beta-Lactamase Assays

Compositions for use in the detection of particular beta-lactamases cancomprise a detectable beta-lactamase substrate. Any beta-lactamasesubstrate that is readily detectable may be used in the compositionspresented herein. Non-limiting examples of detectable beta-lactamasesubstrates include chromogenic substrates, fluorogenic substrates, andantibiotics. Chromogenic beta-lactamase substrates include, but are notlimited to, nitrocefin(3-[2,4-dinitrostyryl]-7-(2-thienylacetamido]3-cephem-4-carobxylic acid(Calbiochem, San Diego, Calif.)), PADAC®(Pyridinium-2-azo-p-dimethylaniline chromophore (Calbiochem. San Diego,Calif.)), CENTA™ (EMD Chemicals, Inc., San Diego, Calif.), HMRZ-86((7R)-7[2-aminothiazol-4-yl]-(z)-2-(1-carboxy-1-methylethoxyimino)acetamido)-3-(2,4-dinitrostyryl)-3-cephem-4-carboxylicacid trifluoroacetate, E-isomer (Kanto Chemical Co., Inc. Tokyo,Japan)), and cefesone. Fluorogenic substrates include, but are notlimited to, Fluorcillin Green 495/525 and Fluorocillin Green 345/350LIVE BLAZER™-FRET B/G (Invitrogen, Carlsbad, Calif.). Antibioticsinclude beta-lactams, penicillin, amoxicillin, etc. In a specificembodiment, the concentration of substrate that exhibits substrateutilization as detected by a technique know to one of skill in the art,such as spectrophotometry and visual observation, is used in thecompositions presented herein.

In a specific embodiment, the detectable beta-lactamase substrate isnitrocefin. In a particular embodiment, nitrocefin is present in acomposition described herein at a concentration of about 1 μM to about 1mM, about 1 μM to about 750 μM, about 1 μM to about 500 μM, or about 1to about 250 μM. In another embodiment, nitrocefin is present in acomposition described herein at a concentration of about 20 μM to about200 μM.

In another embodiment, the detectable beta-lactamase substrate isCENTAT™. In a particular embodiment, CENTA™ is present in a compositiondescribed herein at a concentration of about 1 μM to about 1 mM, about 1μM to about 750 μM, about 1 μM to about 500 μM, or about 1 μM to about250 μM. In another embodiment, CENTA™ is present in a compositiondescribed herein at a concentration of about 20 μM to about 200 μM.

In another embodiment, the detectable beta-lactamase substrate isHMRZ-86. In a particular embodiment, HMRZ-86 is present in a compositiondescribed herein at a concentration of about 1 μM to about 1 mM, about 1μM to about 750 μM, about 1 μM to about 500 μM, or about 1 μM to about250 μM. In another embodiment, HMRZ-86 is present in a compositiondescribed herein at a concentration of about 20 μM to about 200 μM.

In addition to a detectable beta-lactamase substrate, the compositionsfor use in the methods presented herein may comprise one, two or more ofthe following beta-lactamase inhibitors: an AmpC inhibitor, a serinebeta-lactamase inhibitor, a metal chelator and an ESBL inhibitor. In aspecific embodiment, a composition comprises a detectable beta-lactamasesubstrate and an AmpC inhibitor. In another embodiment, a compositioncomprises a detectable beta-lactamase substrate, an AmpC inhibitor and aserine beta-lactamase inhibitor in an amount sufficient to inhibit ESBLand an OSBL but not a class A serine carbapenemase. In anotherembodiment, a composition comprises a detectable beta-lactamasesubstrate, an AmpC inhibitor, a serine beta-lactamase inhibitor in anamount sufficient to inhibit ESBL and an OSBL but not a class A serinecarbapenemase, and a metal chelator. In another embodiment, acomposition comprises a detectable beta-lactamase substrate and a serinebeta-lactamase inhibitor in an amount sufficient to inhibit ESBL and anOSBL but not a class A serine carbapenemase. In another embodiment, acomposition comprises a detectable beta-lactamase substrate and a metalchelator. In another embodiment, a composition comprises a detectablebeta-lactamase substrate and an ESBL inhibitor. As one of skill in theart will appreciate, the concentration of bacteria and the concentrationof detectable beta-lactamase substrate will affect the concentration ofan inhibitor added to a composition. Further, one of skill in the artwill be able to routinely determine the concentration range of aninhibitor to use in a composition empirically by contacting a positivecontrol bacterial sample (and optimally a negative control bacterialsample) with different compositions, each composition comprisingdifferent combinations of detectable beta-lactamase substrate and/orinhibitor.

As used herein, the term “AmpC inhibitor” refers to an agent that atparticular concentrations inhibits the enzymatic activity of AmpC, butnot the enzymatic activity of serine carbapenemases,metallo-beta-lactamases, OSBL and ESBL. Non-limiting examples of an AmpCinhibitor include cloxacillin (VWR, Pennsylvania, USA), salt forms ofcloxacillin, syn2190 (NAEJA Pharmaceutical, Inc., Edmonton, Alberta,Canada), salt forms of cloxacillin (such as a sodium or potassium saltform of cloxacillin), aztreonam (VWR, Pennsylvania, U.S.A.) and boronicacid and its derivatives thereof (Focus Synthesis LLC, San Diego,Calif.), and a combination thereof. In one embodiment, the AmpCinhibitor is cloxacillin. In a specific embodiment, a compositioncomprising an AmpC inhibitor contains about 1 μM to about 100 mM, about1 μM to about 75 mM, about 1 μM to about 50 mM, about 1 μM to about 25mM, about 1 μM to about 10 mM, or about 1 μM to about 5 mM of an AmpCinhibitor. In another embodiment, a composition comprising an AmpCinhibitor contains about 100 μM to about 4 mM, about 200 μM to about 4mM, 500 μM to about 4 mM, about 750 μM to about 4 mM, or about 1 mM toabout 4 mM of an AmpC inhibitor. In another embodiment, a compositioncomprising an AmpC inhibitor contains about 500 μM to about 3 mM, about1 mM to about 3 mM, about 1.5 mM to about 3 mM, or about 2 mM to about 3mM of an AmpC inhibitor. In a particular embodiment, the AmpC inhibitoris cloxacillin. In a specific embodiment, a composition comprises about20 μM to about 5 mM of cloxacillin or a salt form thereof.

As used herein, the term “serine beta-lactamase inhibitor” refers to anagent that at particular concentrations inhibits the enzymatic activityof ESBLs and OSBLs, but not class A serine carbapenemases and AmpC.Non-limiting examples of a serine beta-lactamase inhibitor includeclavulanic acid (GlaxoSmithKline, UK), salt forms of clavulanic acid(such as a sodium salt form of clavulanic acid), tazobactum (WyethAyerst Research, New York, U.S.A.), sulbactam (Pfizer, New York,U.S.A.), and a combination thereof. In one embodiment, the serinebeta-lactamase inhibitor is clavulanic acid. In a specific embodiment, acomposition comprising clavulanic acid or a salt form thereof in anamount sufficient to inhibit an ESBL and an OSBL but not a class Aserine carbapenemase contains about 10 μM to about 100 mM, about 10 μMto about 75 mM, about 10 μM to about 50 mM, about 10 μM to about 25 mM,about 10 μM to about 10 mM, or about 10 μM to about 5 mM of clavulanicacid or a salt form thereof. In another embodiment, a compositioncomprising clavulanic acid or a salt form thereof in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase contains about 10 μM to about 2 mM, about 25 μM to about 2mM, 50 μM to about 2 mM, about 75 μM to about 2 mM, or about 100 μM toabout 2 mM of clavulanic acid or a salt form thereof. In anotherembodiment, a composition comprising clavulanic acid or a salt formthereof in an amount sufficient to inhibit an ESBL and an OSBL but not aclass A serine carbapenemase contains about 200 μM to about 2 mM, about250 μM to about 2 mM, about 300 μM to about 2 mM, about 400 μM to about2 mM, or about 500 μM to about 2 mM of clavulanic acid or a salt formthereof. In another embodiment, a composition comprising clavulanic acidor a salt form thereof in an amount sufficient to inhibit an ESBL and anOSBL but not a class A serine carbapenemase contains about 1 μM to about2 mM, a bout 1 μM to about 1.5 mM, about 1 μM to about 1 mM, about 1 μMto about 750 μM, about 1 μM to about 500 μM, about 1 μM to about 250 μM,or about 1 μM to 50 μM of clavulanic acid or a salt form thereof. In aparticular embodiment, a composition comprising clavulanic acid or asalt form thereof in an amount sufficient to inhibit an ESBL and an OSBLbut not a class A serine carbapenemase contains about 500 μM to about1.5 mM of clavulanic acid or a salt form thereof. In one embodiment, theserine beta-lactamase inhibitor is tazobactum. In a specific embodiment,a composition comprising tazobactum or a salt form thereof in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase contains about 100 μM to about 1 mM, about 100 μM to about750 μM, about 100 μM to about 500 μM, or about 100 μM to about 250 μM oftazobactum or a salt form thereof. In another embodiment, the serinebeta-lactamase inhibitor is sulbactam. In a specific embodiment, acomposition comprising sulbactam or a salt form thereof in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase contains about 100 μM to about 5 mM, about 100 μM to about4 mM, about 100 μM to about 3 mM, about 100 μM to about 2 mM, or about100 μM to about 1 mM of sulbactam or a salt form thereof. In anotherembodiment, a composition comprising sulbactam or a salt form thereof inan amount sufficient to inhibit an ESBL and an OSBL but not a class Aserine carbapenemase contains about 100 μM to about 750 μM, about 100 μMto about 500 μM, 100 μM to about 250 μM, about 100 μM to about 200 mM,or about 100 μM to about 150 μM of sulbactam or a salt form thereof.

Non-limiting examples of a metal chelator include dipicolinic acid(DPC), diethyldithiocarbamate (DEDTC),N,N,N′,N′-tetrakis-(2-pyridylmethyl)-ethylenediamine (TPEN) (VWR,Pennsylvania, U.S.A.), EDTA (VWR, Pennsylvania, U.S.A.),2,3-dimercapto-1-propane sulfonic acid (DMPS) (Sigma, St. Louis, Mo.,U.S.A.) and 1,10-phenanthroline (Sigma, St. Louis, Mo., U.S.A.). In aspecific embodiment, the metal chelator is zinc-specific. TPEN is anon-limiting example of a zinc-specific metal chelator. In alternativeembodiment, the metal chelator is able to bind to zinc but is notzinc-specific. DMPS, EDTA, 1,10-phenathroline, DPC and DEDTC arenon-limiting examples of metal chelators that are not zinc-specific. Ina preferred embodiment, the metal chelator is membrane permeable. Insome embodiments, a composition comprise EDTA, DMPS,1,10-phenanthroline, DPC, DEDTC or TPEN at a concentration of about 0.5mM to about 200 mM, about 1 mM to about 100 mM, or about 1 mM to about50 mM. In a specific embodiment, a composition comprises DPC at aconcentration of about 0.5 mM to about 10 mM, about 0.5 mM to about 7mM, about 0.5 mM to about 5 mM, about 0.5 mM to about 2 mM or about 0.5mM to about 1 mM. In another embodiment, a composition comprises DEDTCat a concentration of about 1 mM to about 20 mM, about 1 mM to about 15mM, about 1 mM to about 10 mM, about 1 mM to about 7 mM, about 1 mM toabout 5 mM or about 1 mM to about 2 mM.

As used herein, the term “ESBL inhibitor” refers to an agent that atparticular concentrations inhibits the enzymatic activity of ESBLs, butnot the enzymatic activity of OSBLs. Non-limiting examples of an ESBLinhibitor include ceftazidime (GlaxoSmithKline, UK), a salt form ofceftazidime, cefotaxime (MP Biomedicals, Solon, Ohio, U.S.A.), a saltform of cefotaxime and a combination thereof. In one embodiment, theESBL inhibitor is ceftazidime. In a specific embodiment, a compositioncomprises ceftazidime or a salt form thereof at a concentration of about1 mM to about 20 mM, about 1 mM to about 15 mM, about 1 mM to about 10mM, about 1 mM to about 7 mM, about 1 mM to about 5 mM, or about 1 mM toabout 2 mM. In another embodiment, the ESBL inhibitor is cefotaxime or asalt form thereof. In a specific embodiment, a composition comprisescefotaxime or a salt form thereof at a concentration of about 1 mM toabout 20 mM, about 1 mM to about 15 mM, about 1 mM to about 10 mM, about1 mM to about 7 mM, about 1 mM to about 5 mM, or about 1 mM to about 2mM. In another embodiment, the ESBL inhibitor is a combination ofceftazidime and cefotaxime. In a specific embodiment, a compositioncomprises a combination of ceftazidime or a salt form thereof andcefotaxime or a salt form thereof at a concentration of about 1 mM toabout 20 mM, about 1 mM to about 15 mM, about 1 mM to about 10 mM, about1 mM to about 7 mM, about 1 mM to about 5 mM, or about 1 mM to about 2mM.

In addition to a detectable beta-lactamase substrate and one or morebeta-lactamase inhibitors, the compositions for use in the detection ofone or more beta-lactamases may include a buffer. Any buffer that aidsin maintaining the pH of the composition and does not interfere witheither the hydrolysis of the beta-lactamase substrate or the activity ofone or more beta-lactamase inhibitors, or both may be used. Non-limitingexamples of buffers include phosphate MES buffer, acetate buffer, Trisbuffer, ADA buffer, MDPS buffer, and HEPES buffer. In a specificembodiment, a composition comprises 0.05 to 1 ml of phosphate or MESbuffer.

In some embodiments, in addition to a detectable beta-lactamasesubstrate and one or more beta-lactamase inhibitors, the compositionscomprise an agent such as an enzyme, non-ionic detergent or EDTA tofacilitate the rupture of the cell wall of the bacteria. As one of skillin the art will appreciate, the use of EDTA in a composition presentedherein, may, depending upon the concentration, inhibitmetallo-beta-lactamases. Accordingly, one of skill in the art shouldconsider this before adding EDTA to a composition presented herein. In apreferred embodiment, the compositions do not comprise an additionalagent that facilitates the rupture of cell wall of the bacteria.

In certain embodiments, in addition to a detectable beta-lactamasesubstrate and one or more beta-lactamase inhibitors, the compositionsdescribed herein comprise a lysis reagent. Lysis reagents are known toone of skill in the art. In a specific embodiment, the lysis reagentlyses the bacterial cells but does not interfere with either thehydrolysis of the beta-lactamase substrate or the activity of one ormore beta-lactamase inhibitors, or both. In one embodiment, the lysisreagent is a detergent, such as a mild non-denaturing detergent (e.g.,Triton® X-100 or CHAPS). In another embodiment, the lysis reagent is anenzyme or other agent that promotes the lysis of a bacterial cell.Non-limiting examples of such an enzyme include lysozyme, labiase,lysostaphin, achromopeptidase, and mutanolysin. In a particularembodiment, the compositions described herein comprise about 0.1 mg/mlto about 10 mg/ml, about 0.5 mg/ml to about 10 mg/ml, about 1 mg/ml toabout 10 mg/ml, about 2 mg/ml to about 10 mg/ml, about 3 mg/ml to about10 mg/ml, about 4 mg/ml to about 10 mg/ml or about 5 mg/ml to about 10mg/ml of an enzyme or other agent that promotes the lysis of a bacterialcell. In another embodiment, the compositions described herein compriseabout 0.1 mg/ml to about 8 mg/ml, about 1 mg/ml to about 6 mg/ml, about1 mg/ml to about 5 mg/ml, about 1 mg/ml to about 5 mg/ml, about 2 mg/mlto 4 mg/ml, or about 3 mg/ml of an enzyme or other agent that promotesthe lysis of a bacterial cell.

In a specific embodiment, the compositions described herein compriselysozyme. In a particular embodiment, the compositions described hereincomprise about 0.1 mg/ml to about 10 mg/ml, about 0.5 mg/ml to about 10mg/ml, about 1 mg/ml to about 10 mg/ml, about 2 mg/ml to about 10 mg/ml,about 3 mg/ml to about 10 mg/ml, about 4 mg/ml to about 10 mg/ml orabout 5 mg/ml to about 10 mg/ml of lysozyme. In another embodiment, thecompositions described herein comprise about 0.1 mg/ml to about 8 mg/ml,about 1 mg/ml to about 6 mg/ml, about 1 mg/ml to about 5 mg/ml, about 1mg/ml to about 5 mg/ml, about 2 mg/ml to 4 mg/ml, or about 3 mg/ml oflysozyme.

In certain embodiments, the compositions described herein comprise alysis reagent (e.g., lysozyme, labiase, lysostaphin, achromopeptidase,or mutanolysin) and an agent that promotes the stabilization of thelysis reagent. In a specific embodiment, the agent that promotes thestabilization of the lysis reagent does not interfere with either thehydrolysis of the beta-lactamase substrate or the activity of one ormore beta-lactamase inhibitors, or both. In one embodiment, the agentthat promotes the stabilization of the lysis reagent is thermal stable.In a particular embodiment, the compositions described herein compriseabout 0.1% to about 10%, about 1% to about 10%, about 2% to about 10%,about 4% to about 10%, about 1% to about 8%, about 2% to about 8%, about2% to about 6%, or about 2% to about 4% of an agent that promotes thestabilization of the lysis reagent.

In a specific embodiment, the compositions described herein comprise alysis reagent and a carbohydrate, e.g., a monosaccharide, adisaccharide, a polysaccharide, an oligosaccharide, or a polyol.Specific examples of carbohydrates include, but are not limited to,mannitol, ribose, glucose, fructose, mannose, sucrose, lactose,glycerol. Xanthan gum, trehalose and glycols (e.g., propylene glycol).In a specific embodiment, the carbohydrate is trehalose.

In a specific embodiment, the compositions described herein compriselysozyme and trehalose. In a particular embodiment, the compositionsdescribed herein comprise about 0.1 mg/ml to about 10 mg/ml, about 0.5mg/ml to about 10 mg/ml, about 1 mg/ml to about 10 mg/ml, about 2 mg/mlto about 10 mg/ml, about 3 mg/ml to about 10 mg/ml, about 4 mg/ml toabout 10 mg/ml or about 5 mg/ml to about 10 mg/ml of lysozyme and about0.1% to about 10%, about 1% to about 10%, about 2% to about 10%, about4% to about 10%, about 1% to about 8%, about 2% to about 8%, about 2% toabout 6%, or about 2% to about 4% of trehalose. In another embodiment,the compositions described herein comprise about 0.1 mg/ml to about 8mg/ml, about 1 mg/ml to about 6 mg/ml, about 1 mg/ml to about 5 mg/ml,about 1 mg/ml to about 5 mg/ml, about 2 mg/ml to 4 mg/ml, or about 3mg/ml of lysozyme and about 0.1% to about 10%, about 1% to about 10%,about 2% to about 10%, about 4% to about 10%, about 1% to about 8%,about 2% to about 8%, about 2% to about 6%, or about 2% to about 4% oftrehalose.

In certain embodiments, the compositions described herein comprise alysis reagent (e.g., lysozyme, labiase, lysostaphin, achromopeptidase,or mutanolysin) and an additional agent, e.g., an agent that enhancesthe lysis of a bacterial cell by a lysis reagent (e.g., a metalchelator). In certain embodiments, the compositions described hereincomprise a lysis reagent (e.g., lysozyme, labiase, lysostaphin,achromopeptidase, or mutanolysin), an agent that promotes thestabilization of the lysis reagent, and an additional agent, e.g., anagent that enhances the lysis of a bacterial cell by a lysis reagent(e.g., a metal chelator). In a specific embodiment, the agent thatenhances the lysis of a bacterial cell by a lysis reagent does notinterfere with either the hydrolysis of the beta-lactamase substrate orthe activity of one or more beta-lactamase inhibitors, or both. Inspecific embodiments, an agent that enhances the lysis of a bacterialcell by a lysis reagent increases rate at which the lysis reagent lysesbacterial cells by about 10%, about 20%, about 25%, about 30%, about40%, about 50%, about 60% or about 75% relative the rate at which thelysis reagent lyses bacterial cells in the absence of the agent. Inother embodiments, an agent that enhances the lysis of a bacterial cellby a lysis reagent increases rate at which the lysis reagent lysesbacterial cells by about 10% to about 50%, about 10% to about 75%, about25% to about 75%, about 25% to about 50%, about 25% to about 40%, about25% to about 30% or about 50% or about 75% relative the rate at whichthe lysis reagent lyses bacterial cells in the absence of the agent. Inone embodiment, the compositions described herein comprise about 0.1 mMto about 5 mM, about 1 mM to about 4 mM, about 1 mM to about 3 mM, about2 mM to about 3 mM, or about 0.1 to about 2 mM of an agent that enhancesthe lysis of a bacterial cell by a lysis reagent.

In a specific embodiment, the compositions described herein comprise alysis reagent (e.g., lysozyme, labiase, lysostaphin, achromopeptidase,or mutanolysin), an agent that promotes the stabilization of the lysisreagent, and EDTA or EGTA. In particular embodiments, either EDTA orEGTA, or both are not utilized if a metallo-beta-lactamase is or may bedetected.

In a specific embodiment, the compositions described herein comprise alysozyme, trehalose and EDTA. In a particular embodiment, thecompositions described herein comprise about 0.1 mg/ml to about 10mg/ml, about 0.5 mg/ml to about 10 mg/ml, about 1 mg/ml to about 10mg/ml, about 2 mg/ml to about 10 mg/ml, about 3 mg/ml to about 10 mg/ml,about 4 mg/ml to about 10 mg/ml or about 5 mg/ml to about 10 mg/ml oflysozyme, about 0.1% to about 10%, about 1% to about 10%, about 2% toabout 10%, about 4% to about 10%, about 1% to about 8%, about 2% toabout 8%, about 2% to about 6%, or about 2% to about 4% of trehalose,and about 0.1 mM to about 5 mM, about 1 mM to about 4 mM, about 1 mM toabout 3 mM, about 2 mM to about 3 mM, or about 0.1 to about 2 mM ofEDTA. In another embodiment, the compositions described herein compriseabout 0.1 mg/ml to about 8 mg/ml, about 1 mg/ml to about 6 mg/ml, about1 mg/ml to about 5 mg/ml, about 1 mg/ml to about 5 mg/ml, about 2 mg/mlto 4 mg/ml, or about 3 mg/ml of lysozyme, about 0.1% to about 10%, about1% to about 10%, about 2% to about 10%, about 4% to about 10%, about 1%to about 8%, about 2% to about 8%, about 2% to about 6%, or about 2% toabout 4% of trehalose, and about 0.1 mM to about 5 mM, about 1 mM toabout 4 mM, about 1 mM to about 3 mM, about 2 mM to about 3 mM, or about0.1 to about 2 mM of EDTA.

The compositions can be any form amenable to detection of substrateutilization following contact of a composition with a bacterial sample.For example, the compositions may be in the form of a liquidcomposition, a tablet, embedded in an agar plate, a paper disk, a paperstrip, a dry form in wells, or a dry form in one or more tubes. In aspecific embodiment, the compositions are liquid compositions with eachliquid composition comprising a detectable beta-lactamase substrate andone or more different beta-lactamase inhibitors. The use of liquidcompositions is exemplified in the examples provided in Section 6,infra.

In some embodiments, the compositions are dried and are present on or ina solid support, such as the well of a plate, a panel, a cassette or atray, a paper strip, a paper disk or a tube. In certain embodiments, thecompositions are dried onto or in the solid support using heat attemperatures of, e.g., 50° C. to 100° C., 50° C. to 85° C., 50° C. to75° C., 60° C. to 75° C. or 60° C. to 70° C. In one embodiment, thecompositions are dried onto or in the solid support using heat underforced air or vacuum conditions at temperatures of, e.g., 50° C. to 100°C., 50° C. to 85° C., 50° C. to 75° C. 60° C. to 75° C. or 60° C. to 70°C. In other embodiments, the compositions are dried onto or in the solidsupport using a lypholization technique. In other embodiments, thecompositions are dried onto or in the solid support using a spray dryingtechnique.

In another embodiment, the compositions are part of one agar plate thatis divided up into different sections with each section comprising adifferent composition. For example, the agar plate may comprise threesections with each section comprising a composition comprising adetectable beta-lactamase substrate and one or more differentbeta-lactamase inhibitors. In another embodiment, there is only onecomposition per agar plate. In other words, each agar plate onlycomprises one composition so that two or more agar plates comprisingdifferent compositions are utilized in the methods presented herein.

In another embodiment, the compositions are part of a paper disk orpaper strip that is divided up into different sections with each sectioncomprising a different composition. For example, the paper disk or paperstrip may comprise three sections with each section comprising acomposition comprising a detectable beta-lactamase substrate and one ormore different beta-lactamase inhibitors. In another embodiment, thereis only one composition per paper disk or paper strip. In other words,each paper disk or paper strip only comprises one composition so thattwo or more paper disks or paper strips comprising differentcompositions are utilized in the methods presented herein. In a specificembodiment, the paper disk or paper strip is filter paper. In anotherspecific embodiment, the compositions are presented in a form similar toBBL™ Dryslide™ Nitrocefin (Becton Dickinson, Diagnostic Systems, USA).

In certain embodiments, the compositions described herein are dried andare present in the wells of a panel, tray, cassette or plate (e.g., amicrotiter plate). In specific embodiments, the compositions describedherein are dried and are present in the wells of a tray or panel, suchas a well of the Phoenix™ Panel (BD, USA), a well of a panel for theBBL™ Crystal™ Identification System (BD, USA), a Vitek® card(bioMerieux, USA), a well of a MicroScan panel (Dade Behring, USA), or awell of a panel for the Remel RapID™ System (Remel, USA). See, e.g.,U.S. Pat. No. 5,922,593 and Des. 421,498 (each of which are incorporatedherein by reference) for a description of panels with wells that thecompositions described herein may be dried in or on using, e.g., heat.In some embodiments, the compositions described herein are dried and arepresent in a tube, such as a tube for the API biochemical test(bioMerieux, USA).

In a particular embodiment, the compositions described herein are driedand are present in the wells of a Phoenix™ Panel (BD, USA) and anautomated system, such as the BD Phoenix™ Automated Microbiology System(BD, USA), is used to detect substrate utilization. See, e.g., U.S. Pat.Nos. 5,922,593, 6,372,485, 6,096,272, and 7,115,384 (each of which areincorporated herein by reference) for a description of an automatedsystem for detection of substrate utilization. In a particularembodiment, the compositions described herein are dried and are presentin the wells of a panel for the BBL™ Crystal™ Identification System (BD,USA) and an automated system, such as the BD BBL™ Crystal IdentificationSystem (BD, USA), is used to detect substrate utilization.

In other embodiments, the compositions are dried and are present in thewells of a Vitek® (bioMerieux, USA) and an automated system, such thebioMerieux Vitek® system (bioMerieux, USA), is used to detect substrateutilization. In other embodiments, the compositions are dried and arepresent in the wells of a MicroScan panel (Dade Behring, USA) and anautomated system, such as the MicroScan Walk-Away® system, is used todetect substrate utilization (Dade Behring; USA).

In certain embodiments, the compositions described herein are in theform of a tablet. The tablet and a bacterial cell suspension may becombined in any type of container (e.g., the wells of a microtiterplate, a test tube, or an Eppendorf tube), and substrate utilization maybe detected by an appropriate technique or device which will varydepending upon the substrate chosen.

In certain embodiments, the compositions described herein are in theform of a dry powder. The dry powder and a bacterial cell suspension maybe combined in any type of container (e.g., the wells of a microtiterplate, a test tube, or an Eppendorf tube), and substrate utilization maybe detected by an appropriate technique or device which will varydepending upon the substrate chosen.

4.3 Bacterial Samples

A bacterial sample isolated, obtained or derived from a biologicalsample from any source can be used in the methods presented herein. Inone embodiment, a bacterial sample is isolated, obtained or derived froma biological sample obtained from a subject, e.g., a human subject.Examples of subjects from which such a biological sample may be obtainedand utilized in accordance with the methods presented herein include,but are not limited to, asymptomatic subjects, subjects manifesting orexhibiting 1, 2, 3, 4 or more symptoms of an infection, subjectsclinically diagnosed as having an infection, subjects predisposed toinfections (e.g., subjects with a genetic predisposition to infections,and subjects that lead a lifestyle that predisposes them to infectionsor increases the likelihood of contracting an infection), subjectssuspected of having an infection, subjects undergoing therapy for aninfection, subjects with an infection and at least one other condition(e.g., subjects with 2, 3, 4, 5 or more conditions), subjects notundergoing therapy for an infection, and subjects that have not beendiagnosed with an infection. In one embodiment, the infection is a gramnegative bacterial infection. In another embodiment, the infection is agram positive bacterial infection. Non-limiting examples of bacteriathat cause bacterial infections include E. coli, Klebsiella (e.g.,Klebsiella pneumoniae and Klebsiella oxytoca), Staphylococcus (e.g.,Staphylococcus aureus), Streptococcus (e.g., Streptococcus pneumoniae),Haemophilus influenzae, Neisseria gonorrhoeae, Pseudomonas (e.g.,Pseudomonas aeruginosa), Enterococcus and Acinetobacter baumannii.

In one embodiment, the subject is a mammal such as a non-primate (e.g.,a cow, dog, pig, cat, dog, horse, etc.) and a primate (e.g., a human).In another embodiment, the subject is a non-human animal, such as abird, reptile, and a non-human mammal. In another embodiment, thesubject is a farm animal (e.g., a pig, horse, or cow), a pet (e.g., aguinea pig, dog, or cat) and/or a laboratory animal (e.g., a rat ormouse). In a preferred embodiment, the subject is a human.

A biological sample can be obtained from any tissue or organ in asubject, or a secretion from a subject. Representative biologicalsamples from a subject include, without limitation, nasal swabs, throatswabs, feces, dermal swabs, blood (including blood culture), sputum,salvia, bronchio-alveolar lavage, bronchial aspirates, lung tissue,spinal fluid, synovial fluid and urine. In some embodiments, two, threeor more biological samples are obtained from a subject. In specificembodiments, two or more biological samples are obtained from two ormore tissues, organs and/or secretions from a subject. In addition toobtaining a biological sample from a subject, a biological sample may beobtained from food, a beverage, a phone, a counter, etc. Techniques forcollecting biological samples are known to those of skill in the art.

In some embodiments, a biological sample is stored before use. Forexample, a biological sample from a subject can be stored at 4° C., −30°C. or −70° C. Techniques for storing biological samples are known to oneof skill in the art.

In some embodiments, after a biological sample is obtained, thebiological sample can be processed so that a pure bacterial sample isobtained or the biological sample can be stored before processing usingtechniques known to one of skill in the art. Any technique known to oneof skill in the art may be used to obtain a pure bacterial sample.Generally, a biological sample is streaked onto a solid agar-containingmedium so as to separate the bacterial population present in thebiological sample into individual cells that grow as individualcolonies. The media chosen as well as the growth conditions (e.g., thetemperature and gases in the environment) will depend upon the bacteriabeing selected. For example, Trypticase™ Soy Agar with 5% sheep blood(BD, USA), incubated at 35° C. for 18 hours may be used to obtainindividual bacterial colonies. In certain embodiments, a pure bacterialsample is used within 24 hours as a bacterial sample. In someembodiments, a pure bacterial sample is stored before use (e.g., at 4°C. or −70° C.). Techniques for storing bacterial samples are known toone of skill in the art. In some embodiments, an aliquot or inoculum ofthe pure bacterial sample is used as a bacterial sample. In otherembodiments, an aliquot or inoculum of the pure bacterial sample islysed and the bacterial cell extract produced is used as a bacterialsample. In some embodiments, the bacterial cell extract is stored beforeuse.

In other embodiments, after obtaining a biological sample, thebiological sample can be used to inoculate media and the inoculatedmedia is incubated for a certain period of time to allow any bacteriapresent in the sample to proliferate. The media chosen as well as thegrowth conditions (e.g., temperature will depend upon the bacteria beingcollected). For example, Trypticase™ Soy Agar with 5% sheep blood (BD,USA), incubated at 35° C. for 18 hours may be used. In some embodiments,the bacterial culture is stored before use (e.g., at 4° C. or −70° C.).Techniques for storing bacterial cultures are known to one of skill inthe art. In some embodiments, an aliquot or inoculum of the bacteria inthe culture is used as a bacterial sample. In other embodiments, analiquot or inoculum of the bacteria in the culture is lysed and thebacterial cell extract produced is used as a bacterial sample. In someembodiments, the bacterial cell extract is stored before use.

In some embodiments, a bacterial sample is stored before use. Forexample, a bacterial sample is stored at 4° C.

In certain embodiments, a sample of bacteria isolated, obtained orderived from a biological sample from any source is added to a buffer tomake a cell suspension and an aliquot of the cell suspension is used asa bacterial sample. In some embodiments, a sample of bacteria isolated,obtained or derived from a biological sample from any source is added tosterile water to make a cell suspension and an aliquot of the cellsuspension is used as a bacterial sample. In specific embodiments, asample of bacteria isolated, obtained or derived from a biologicalsample from any source is added to a saline buffer or a broth (e.g., ASTbroth or ID broth sold as part of a kit for the BD Phoenix™ AutomatedMicrobiology System (BD, USA)) to make a cell suspension and an aliquotof the cell suspension is used as a bacterial sample.

In certain embodiments, a pure bacterial sample is added to a buffer tomake a cell suspension and an aliquot of the cell suspension is used asa bacterial sample. In some embodiments, a pure bacterial sample isadded to sterile water to make a cell suspension and an aliquot of thecell suspension is used as a bacterial sample. In specific embodiments,a pure bacterial sample is added to a saline buffer or a broth (e.g.,AST broth or ID broth sold as part of a kit for BD Phoenix™ AutomatedMicrobiology System (BD, USA)) to make a cell suspension and an aliquotof the cell suspension is used as a bacterial sample. In a particularembodiment, the pure bacterial sample is added to the buffer, sterilewater or broth within 24 hours or less of the generation of the purebacterial sample.

In specific embodiments, a sample of bacteria isolated, obtained orderived from a biological sample from any source is lysed and an aliquotof the bacterial cell extract produced is used as a bacterial sample.Techniques for lysing bacteria are known to one of skill in the art.Non-limiting examples of techniques for lysing bacteria include themechanical disruption techniques, freeze/thawing techniques, and lysisbuffer techniques. For example, bacteria may be lysed utilizingmechanical force such as, e.g., a blender or grinder. When a samplevolume is small, liquid homogenization or sonication may be used to lysebacteria. Lysis buffer comprising one or more detergents, such as mildnon-denaturing detergents (e.g., Triton® X-100 or CHAPS), may also beused to lyse bacteria. Lysis buffer comprising one or more enzymes(e.g., lysozyme, labiase, lysostaphin, achromopeptidase, or mutanolysin)or other agents that promote bacterial cell lysis may be used to lysebacteria. In a specific embodiment, a lysis buffer comprising lysozymeand a metal chelator (e.g., EDTA or EGTA) may be used to lyse bacteria.In another embodiment, a lysis buffer comprising lysozyme and an agentthat promotes the stabilization of the lysis reagent may be used to lysebacteria. In another embodiment, a lysis buffer comprising lysozyme, anagent that promotes the stabilization of the lysis reagent and a metalchelator (e.g., EDTA or EGTA) may be used to lyse bacteria. In someembodiments, the bacterial cell extract is stored before use.

4.4 Characterization of Bacteria

In addition to or in conjunction with the beta-lactamase assayspresented herein, a bacterial sample can be characterized usingtechniques known to one of skill in the art. For example, a bacterialsample may be observed for the morphology of the bacteria and/ordifferent staining reactions may be performed. The morphologicalcharacteristics and staining reactions can aid in the identification ofthe bacteria. In a specific embodiment, a gram stain is performed usingtechniques known to one of skill in the art. In certain embodiments, thegram stain is performed before the beta-lactamase assays presentedherein. In another embodiment, an assay to identify the species ofbacteria is performed using techniques known to one of skill in the art.In a specific embodiment, an ID run on an automated antibioticsusceptibility instrument, such as the BD Phoenix ID/AST System, isperformed to identify the species of bacteria.

4.5 Selection of Therapy

Detection of the presence of a specific beta-lactamase utilizing themethods presented herein can provide information for the selection of anappropriate therapeutic regimen for a patient diagnosed with a bacterialinfection. For example, detecting the presence of a specificbeta-lactamase in a bacterial source may indicate what antibioticsshould not be used to treat an infection caused by the bacteria andsuggest alternative therapies, e.g., other beta lactam drugs that thebacteria is not resistant to or non-beta lactam drugs. In addition tofacilitating the appropriate therapeutic regimen for a patient, thedetection of the presence of a specific beta-lactamase in a bacterialsource may aid in reducing the transmission of beta-lactamase to otherbacteria and/or reduce the spread of beta lactam-resistant bacteria.

4.6 Kits

Presented herein are kits for detecting the presence of particularbeta-lactamases. The kits presented herein may comprise one or more ofthe compositions described herein. In one embodiment, the kits comprise,in one or more containers: (a) a first composition comprising adetectable beta-lactamase substrate and an AmpC inhibitor; and (b) asecond composition comprising a detectable beta-lactamase substrate, anAmpC inhibitor, and a serine beta-lactamase inhibitor in an amountsufficient to inhibit an ESBL and an OSBL but not a class A serinecarbapenemase. In some embodiments, the kits further comprise a thirdcomposition comprising a detectable beta-lactamase substrate, an AmpCinhibitor, a serine beta-lactamase inhibitor in an amount sufficient toinhibit an ESBL and an OSBL but not a class A serine carbapenemase, anda metal chelator. In some embodiments, the kits further comprise afourth composition comprising a detectable beta-lactamase substrate anda serine beta-lactamase inhibitor in an amount sufficient to inhibit anESBL and an OSBL but not a class A serine carbapenemase. In someembodiments, the kits further comprise a fifth composition comprising adetectable beta-lactamase substrate and an ESBL inhibitor. In someembodiments, the kits further comprise a sixth composition comprising adetectable beta-lactamase substrate and no beta-lactamase inhibitor. Incertain embodiments, each of these compositions further comprises alysis reagent, and optionally, an agent that promotes the stabilizationof the lysis reagent and/or an agent that enhances the lysis of abacterial cell by a lysis reagent.

In another embodiment, the kits comprise, in one or more containers: (a)a first composition comprising a detectable beta-lactamase substrate andan AmpC inhibitor; (b) a second composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase; and (c) a third composition comprising adetectable beta-lactamase substrate and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase. In some embodiments, the kits furthercomprise a fourth composition comprising a detectable beta-lactamasesubstrate and no beta-lactamase inhibitor. In certain embodiments, eachof these compositions further comprises a lysis reagent, and optionally,an agent that promotes the stabilization of the lysis reagent and/or anagent that enhances the lysis of a bacterial cell by a lysis reagent.

In another embodiment, the kits comprise, in one or more containers: (a)a first composition comprising a detectable beta-lactamase substrate andan AmpC inhibitor; (b) a second composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase; and (c) a third composition comprising adetectable beta-lactamase substrate and an ESBL inhibitor. In someembodiments, the kits further comprise a fourth composition comprising adetectable beta-lactamase substrate and no beta-lactamase inhibitor. Incertain embodiments, each of these compositions further comprises alysis reagent, and optionally, an agent that promotes the stabilizationof the lysis reagent and/or an agent that enhances the lysis of abacterial cell by a lysis reagent.

In another embodiment, the kits comprise, in one or more containers: (a)a first composition comprising a detectable beta-lactamase substrate andan AmpC inhibitor; (b) a second composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase; and (c) a third composition comprising adetectable beta-lactamase substrate, an AmpC inhibitor, a serinebeta-lactamase inhibitor in an amount sufficient to inhibit an ESBL andan OSBL but not a class A serine carbapenemase and a metal chelator. Insome embodiments, the kits further comprise a fourth compositioncomprising a detectable beta-lactamase substrate and no beta-lactamaseinhibitor. In certain embodiments, each of these compositions furthercomprises a lysis reagent, and optionally, an agent that promotes thestabilization of the lysis reagent and/or an agent that enhances thelysis of a bacterial cell by a lysis reagent.

In another embodiment, the kits comprise, in one or more containers: (a)a first composition comprising a detectable beta-lactamase substrate andan AmpC inhibitor; (b) a second composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase; (c) a third composition comprising adetectable beta-lactamase substrate, an AmpC inhibitor, a serinebeta-lactamase inhibitor in an amount sufficient to inhibit an ESBL andan OSBL but not a class A serine carbapenemase and a metal chelator; and(d) a fourth composition comprising a detectable beta-lactamasesubstrate and a serine beta-lactamase inhibitor in an amount sufficientto inhibit an ESBL and an OSBL but not a class A serine carbapenemase.In some embodiments, the kits further comprise a fifth compositioncomprising a detectable beta-lactamase substrate and no beta-lactamaseinhibitor. In certain embodiments, each of these compositions furthercomprises a lysis reagent, and optionally, an agent that promotes thestabilization of the lysis reagent and/or an agent that enhances thelysis of a bacterial cell by a lysis reagent.

In another embodiment, the kits comprise, in one or more containers: (a)a first composition comprising a detectable beta-lactamase substrate andan AmpC inhibitor; (b) a second composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase; (c) a third composition comprising adetectable beta-lactamase substrate, an AmpC inhibitor, a serinebeta-lactamase inhibitor in an amount sufficient to inhibit an ESBL andan OSBL but not a class A serine carbapenemase and a metal chelator; (d)a fourth composition comprising a detectable beta-lactamase substrateand a serine beta-lactamase inhibitor in an amount sufficient to inhibitan ESBL and an OSBL but not a class A serine carbapenemase; and (e) afifth composition comprising a detectable beta-lactamase substrate andan ESBL inhibitor. In some embodiments, the kits further comprise asixth composition comprising a detectable beta-lactamase substrate andno beta-lactamase inhibitor. In certain embodiments, each of thesecompositions further comprises a lysis reagent, and optionally, an agentthat promotes the stabilization of the lysis reagent and/or an agentthat enhances the lysis of a bacterial cell by a lysis reagent.

In another embodiment, the kits comprise, in one or more containers: (a)a first composition comprising a detectable beta-lactamase substrate;(b) a second composition comprising a detectable beta-lactamasesubstrate and a metal chelator. In certain embodiments, each of thesecompositions further comprises a lysis reagent, and optionally, an agentthat promotes the stabilization of the lysis reagent and/or an agentthat enhances the lysis of a bacterial cell by a lysis reagent.

The compositions included in the kits presented herein can contain anybeta-lactamase substrate that is readily detectable. Non-limitingexamples of detectable beta-lactamase substrates include, but are notlimited, chromogenic substrates, fluorogenic substrates, andantibiotics. Chromogenic beta-lactamase substrates include nitrocefin(3-[2,4-dinitrostyryl]-7-(2-thienylacetamido]3-cephem-4-carboxylic acid(Calbiochem, San Diego, Calif.), PADAC®(Pyridinium-2-azo-p-dimethylaniline chromophore (Calbiochem, San Diego,Calif.)), CENTA™ (EMD Chemicals, Inc., San Diego, Calif.), HMRZ-86((7R)-7[2-aminothiazol-4-yl]-(z)-2-(1-carboxy-1-methylethoxyimino)acetamido)-3-(2,4-dinitrostyryl)-3-cephem-4-carboxylicacid trifluoroacetate, E-isomer (Kanto Chemical Co., Inc, Tokyo,Japan)), and cefesone. Fluorogenic substrates include Fluorcillin Green495/525 and Fluorocillin Green 345/350 LiveBlazer™—FRET B/G (Invitrogen,Carlsbad, (CA). Antibiotics include beta-lactams, penicillin,amoxicillin, etc.

In one embodiment, each of the compositions included in a kit presentedherein contains the same detectable beta-lactamase substrate. In anotherembodiment, each of the compositions included in a kit presented hereincontain the same or a similar (generally within about 10% of each other)concentration of the same detectable beta-lactamase substrate. In someembodiments, the kits presented herein comprise concentrated solutions,e.g., 2×, 5× or 10× solutions of a detectable beta-lactamase substrate,that can be diluted and added to a composition. In some embodiments, thekits presented herein comprise a detectable beta-lactamase substrate asa frozen reagent. In other embodiments, the kits presented hereincomprise a detectable beta-lactamase substrate as a dried reagent.

In a specific embodiment, the detectable beta-lactamase substrateincluded in the compositions of the kits presented herein is achromogenic substrate. In a more specific embodiment, the detectablebeta-lactamase substrate included in the compositions of the kitspresented herein is nitrocefin. In a particular embodiment, nitrocefinis present in a composition included in the kits presented herein at aconcentration of about 1 μM to about 1 mM, about 1 μM to about 750 μM,about 1 μM to about 500 or about 1 μM to about 250 μM. In anotherembodiment, nitrocefin is present in a composition described herein at aconcentration of about 20 to about 200 μM.

In another embodiment, the detectable beta-lactamase substrate includedin the kits presented herein is CENTA™. In a particular embodiment, acomposition included in the kits presented herein comprises CENTA™ at aconcentration of about 1 μM to about 1 mM, about 1 μM to about 750 μM,about 1 μM to about 500 μM, or about 1 μM to about 250 μM. In anotherembodiment, CENTA™ is present in a composition described herein at aconcentration of about 20 μM to about 200 μM.

In another embodiment, the detectable beta-lactamase substrate includedin the kits presented herein is HMRZ-86. In a particular embodiment, acomposition included in the kits presented herein comprises HMRZ-86 at aconcentration of about 1 μM to about 1 mM, about 1 μM to about 750 μM,about 1 μM to about 500 μM, or about 1 μM to about 250 μM. In anotherembodiment, HMRZ-86 is present in a composition described herein at aconcentration of about 20 μM to about 200 μM.

In one embodiment, one or more of the compositions included in a kitpresented herein contains one or more inhibitors. In another embodiment,for each of the compositions in a kit presented herein that comprisesone or more of the same inhibitors the concentrations of thoseinhibitors is the same or similar (generally within about 10% of eachother). In some embodiments, the kits presented herein compriseconcentrated solutions, e.g., 2×, 5× or 10× solutions, of an inhibitorthat can be diluted and added to a composition. In some embodiments, thekits presented herein comprise an inhibitor as a frozen reagent. Inother embodiments, the kits presented herein comprise an inhibitor as adried reagent. In some embodiments, the kits presented herein comprise acomposition comprising a detectable beta-lactamase substrate and one ormore inhibitors in a form in which the bacteria can be contacted withthe composition in accordance with the methods presented herein. In someembodiments, the kits presented herein comprise all of the componentsthat can be used to make the various compositions of the kits.

In one embodiment, a composition included in the kits presented hereincomprise an AmpC inhibitor at a concentration of about 1 μM to about 100mM, about 1 μM to about 75 mM, about 1 μM to about 50 mM, about 1 μM toabout 25 mM, about 1 μM to about 10 mM, or about 1 μM to about 5 mM ofan AmpC inhibitor. In another embodiment, a composition included in thekits presented herein comprise an AmpC inhibitor at a concentration ofabout 100 μM to about 4 mM, about 200 μM to about 4 mM, 500 μM to about4 mM, about 750 μM to about 4 mM, or about 1 mM to about 4 mM of an AmpCinhibitor. In another embodiment, a composition included in the kitspresented herein comprise an AmpC inhibitor at a concentration of about500 μM to about 3 mM, about 1 mM to about 3 mM, about 1.5 mM to about 3mM, or about 2 mM to about 3 mM of an AmpC inhibitor.

In a specific embodiment, a composition included in the kits presentedherein comprise cloxacillin, a salt form of cloxacillin, syn2190 (NAEJAPharmaceutical, Inc., Edmonton, Alberta, Canada), or boronic acid or itsderivatives thereof (Focus Synthesis LLC, San Diego, Calif.) as the AmpCinhibitor. In a particular embodiment, a composition included in thekits presented herein comprise cloxacillin or a salt form thereof as theAmpC inhibitor. In a specific embodiment, a composition included in thekits presented herein comprises about 20 μM to about 5 mM of cloxacillinor a salt form thereof. In another embodiment, a composition included inthe kits presented herein comprises about 20 μM to about 4 mM, about 20μM to about 3 mM, about 20 μM to about 2 mM, about 20 μM to about 1 mM,about 20 μM to about 750 μM, about 20 μM to about 500 μM, about 20 μM toabout 250 μM, or about 20 μM to about 75 μM of cloxacillin or a saltform thereof.

In another embodiment, a composition included in the kits presentedherein comprise about 500 μM to about 5 mM, about 500 μM to about 4 mM,about 500 μM to about 3 mM, about 500 μM to about 2 mM, or about 500 μMto about 1 mM of cloxacillin or a salt form thereof. In anotherembodiment, a composition comprises about 1 mM to about 5 mM, about 2 mMto about 5 mM, about 1 mM to about 4 mM, about 2 mM to about 4 mM, about1 mM to about 3 mM, or about 1 mM to about 2 mM of cloxacillin or a saltform thereof.

In one embodiment, a composition included in the kits presented hereincomprises a serine beta-lactamase inhibitor. In a particular embodiment,a composition included in the kits presented herein comprises tazobactumor a salt form thereof. In a specific embodiment, a composition includedin the kits presented herein comprises about 100 μM to about 1 mM, about100 μM to about 750 μM, about 100 μM to about 500 μM, or about 100 μM toabout 250 μM of tazobactum or a salt form thereof. In anotherembodiment, a composition included in the kits presented hereincomprises sulbactam or a salt form thereof. In a specific embodiment, acomposition included in the kits presented herein comprises about 100 μMto about 5 mM, about 100 μM to about 4 mM, about 100 μM to about 3 mM,about 100 μM to about 2 mM, or about 100 μM to about 1 mM of sulbactamor a salt form thereof. In another embodiment, a composition included inthe kits presented herein comprises about 100 μM to about 750 about 100μM to about 500 μM, 100 μM to about 250 μM, about 100 μM to about 200mM, or about 100 μM to about 150 μM of sulbactam or a salt form thereof.

In one embodiment, a composition included in the kits presented herein,comprises clavulanic acid or a salt form thereof. In a specificembodiment, a composition included in the kits presented hereincomprises about 10 μM to about 100 mM, about 10 μM to about 75 mM, about10 μM to about 50 mM, about 10 μM to about 25 mM, about 10 μM to about10 mM, or about 10 μM to about 5 mM of clavulanic acid or a salt formthereof. In another embodiment, a composition included in the kitspresented herein comprises about 10 μM to about 2 mM, about 25 μM toabout 2 mM, 50 μM to about 2 mM, about 75 μM to about 2 mM, or about 100μM to about 2 mM of clavulanic acid or a salt form thereof. In anotherembodiment, a composition included in the kits presented hereincomprises about 200 μM to about 2 mM, about 250 to about 2 mM, about 300μM to about 2 mM, about 400 μM to about 2 mM, or about 500 μM to about 2mM of clavulanic acid or a salt form thereof. In a particularembodiment, a composition included in the kits presented hereincomprises about 500 μM to about 1.5 mM of clavulanic acid or a salt formthereof.

In a specific embodiment, a composition included in the kits presentedherein comprise a zinc-specific metal chelator, such as TPEN. Inalternative embodiment, a composition included in the kits presentedherein comprise a metal chelator that is able to bind to zinc but is notzinc-specific, such as DMPS, EDTA. 1,10-phenanthroline, DPC or DEDTC. Ina preferred embodiment, a composition included in the kits presentedherein comprise a metal chelator that is membrane permeable. In someembodiments, a composition comprises EDTA, DMPS, 1,10-phenanthroline,DEDTC, TPEN or DPC at a concentration of about 0.5 mM to about 200 mM,about 1 mM to about 100 mM, or about 1 mM to about 50 mM.

In a specific embodiment, a composition included in the kits presentedherein comprises DPC at a concentration of about 0.5 mM to about 10 mM,about 0.5 mM to about 7 mM, about 0.5 mM to about 5 mM, about 0.5 mM toabout 2 mM or about 0.5 mM to about 1 mM. In another embodiment, acomposition included in the kits presented herein DEDTC at aconcentration of about 1 mM to about 20 mM, about 1 mM to about 15 mM,about 1 mM to about 10 mM, about 1 mM to about 7 mM, about 1 mM to about5 mM or about 1 mM to about 2 mM.

In one embodiment, a composition included in the kits presented hereincomprises an ESBL inhibitor. In one embodiment, a composition includedin the kits presented herein comprises ceftazidime or a salt formthereof. In a specific embodiment, a composition included in the kitspresented herein comprises ceftazidime at a concentration of about 1 mMto about 20 mM, about 1 mM to about 15 mM, about 1 mM to about 10 mM,about 1 mM to about 7 mM, about 1 mM to about 5 mM, or about 1 mM toabout 2 mM. In another embodiment, a composition included in the kitspresented herein comprises cefotaxime or a salt form thereof. In anotherembodiment, a composition included in the kits presented hereincomprises cefotaxime at a concentration of about 1 mM to about 20 mM, toabout 15 mM, about 1 mM to about 10 mM, about 1 mM to about 7 mM, about1 mM to about 5 mM, or about 1 mM to about 2 mM. In another embodiment,a composition included in the kits presented herein comprises acombination of ceftazidime and cefotaxime. In another embodiment, acomposition included in the kits presented herein comprises acombination of ceftazidime and cefotaxime or salt forms thereof at aconcentration of about 1 mM to about 20 mM, about 1 mM to about 15 mM,about 1 mM to about 10 mM, about 1 mM to about 7 mM, about 1 mM to about5 mM, or about 1 mM to about 2 mM.

In some embodiments, the kits described herein contain a compositioncomprising a lysis reagent. In certain embodiments, in addition to abeta-lactamase substrate and in some embodiments, one or morebeta-lactamase inhibitors, the compositions in the kits described hereincomprise a lysis reagent. In a specific embodiment, the lysis reagentlyses the bacterial cells but does not interfere with either thehydrolysis of the beta-lactamase substrate or the activity of one ormore beta-lactamase inhibitors, or both. In one embodiment, the lysisreagent is a detergent, such as mild non-denaturing detergent (e.g.,Triton® X-100 or CHAPS). In another embodiment, the lysis reagent is anenzyme or other agent that promotes the lysis of a bactierial cell.Non-limiting examples of such an enzyme include lysozyme, labiase,lysostaphin, achromopeptidase, or mutanolysin. In a particularembodiment, the kits described herein contain a composition comprisingabout 0.1 mg/ml to about 10 mg/ml, about 0.5 mg/ml to about 10 mg/ml,about 1 mg/ml to about 10 mg/ml, about 2 mg/ml to about 10 mg/ml, about3 mg/ml to about 10 mg/ml, about 4 mg/ml to about 10 mg/ml or about 5mg/ml to about 10 mg/ml of a lysis reagent (e.g., lysozyme). In anotherembodiment, the compositions used in accordance with the methodsdescribed herein comprise about 0.1 mg/ml to about 8 mg/ml, about 1mg/ml to about 6 mg/ml, about 1 mg/ml to about 5 mg/ml, about 1 mg/ml toabout 5 mg/ml, about 2 mg/ml to 4 mg/ml, or about 3 mg/ml of a lysisreagent (e.g., lysozyme). In a specific embodiment, the kits describedherein contain a composition comprising lysozyme.

In some embodiments, the kits described herein contain a compositioncomprising a lysis reagent and an agent that promotes the stabilizationof the lysis reagent. In certain embodiments, in addition to abeta-lactamase subtrate and in some embodiments, one or morebeta-lactamase inhibitors, the compositions in the kits described hereincomprise a lysis reagent and an agent that promotes the stabilization ofthe lysis reagent. In one embodiment, the agent that promotes thestabilization of the lysis reagent is thermal stable. In a particularembodiment, the kits described herein contain a composition comprisingabout 0.1% to about 10%, about 1% to about 10%, about 2% to about 10%,about 4% to about 10%, about 1% to about 8%, about 2% to about 8%, about2% to about 6%, or about 2% to about 4% of an agent that promotes thestabilization of the lysis reagent.

In one embodiment, the kits described herein contain a compositioncomprising a lysis reagent and a carbohydrate, e.g., a monosaccharide, adisaccharide, a polysaccharide, an oligosaccharide, or a polyol.Specific examples of carbohydrates include, but are not limited to,mannitol, ribose, glucose, fructose, mannose, sucrose, lactose,glycerol, Xanthan gum, trehalose and glycols (e.g., propylene glycol).In a specific embodiment, the kits described herein contain acomposition comprising lysozyme and trehalose.

In some embodiments, the kits described herein contain a compositioncomprising a lysis reagent, an agent that promotes the stabilization ofthe lysis reagent, and an additional agent, e.g., an agent that enhancesthe lysis of a bacterial cell by a lysis reagent (e.g., a metalchelator). In one embodiment, the kits described herein contain acomposition comprising about 0.1 mM to about 5 mM, about 1 mM to about 4mM, about 1 mM to about 3 mM, about 2 mM to about 3 mM, or about 0.1 toabout 2 mM of an agent that enhances the lysis of a bacterial cell by alysis reagent.

In a specific embodiment, the kits described herein contain acomposition comprising a lysis reagent, an agent that promotes thestabilization of the lysis reagent, and EDTA or EGTA. In particularembodiments, either EDTA or EGTA, or both are not utilized if ametallo-beta-lactamase is or may be detected. In a specific embodiment,the kits described herein contain a composition comprising a lysozyme,trehalose and EDTA.

In a specific embodiment, for each of the compositions in a kitpresented herein that comprises one or more of the same lysis reagents(and optionally, an agent that promotes the stabilization of the lysisreagent and/or an agent that promotes degradation of a bacterial cellwall) the concentrations of those reagents (and agents) is the same orsimilar (generally within about 10% of each other). In some embodiments,the kits presented herein comprise concentrated solutions, e.g., 2×, 5×or 10× solutions, of lysis reagents that can be diluted and added to acomposition. In some embodiments, the kits presented herein compriseconcentrated solutions, e.g., 2×, 5× or 10× solutions, of agents thatstabilize the lysis reagent which can be diluted and added to acomposition. In some embodiments, the kits presented herein compriseconcentrated solutions, e.g., 2×, 5× or 10× solutions, of agents thatpromote the degradation of a bacterial cell wall which can be dilutedand added to a composition. In some embodiments, the kits presentedherein comprise one, two or all of the following as a frozen reagent oragent: a lysis reagent, an agent that promotes the stabilization of thelysis reagent, and an agent promotes degradation of a bacterial cellwall as a frozen reagent or agent. In other embodiments, the kitspresented herein comprise one, two or all of the following as a driedreagent or agent: a lysis reagent, an agent that promotes thestabilization of the lysis reagent, and an agent enhances the lysis of abacterial cell by a lysis reagent.

In specific embodiments, the kits presented herein comprise acomposition in a form in which the bacteria can be contacted with thecomposition in accordance with the methods presented herein. In oneembodiment, the composition comprises a detectable beta-lactamasesubstrate, a lysis reagent and optionally, one or more inhibitors, anagent that promotes the stabilization of the lysis reagent and/or anagent that enhances the lysis of a bacterial cell by a lysis reagent. Inanother embodiment, the composition comprises a detectablebeta-lactamase substrate, a lysis reagent and one or more inhibitors,and optionally, either or both, an agent that promotes the stabilizationof the lysis reagent and/or an agent that enhances the lysis of abacterial cell by a lysis reagent. In another embodiment, thecomposition comprises a detectable beta-lactamase substrate, a lysisreagent and one or more inhibitors, an agent that promotes thestabilization of the lysis reagent and optionally an agent that enhancesthe lysis of a bacterial cell by a lysis reagent.

In addition to a detectable beta-lactamase substrate and one or morebeta-lactamase inhibitors, the compositions included in the kitspresented herein may include a buffer. Any buffer that aids inmaintaining the pH of the composition and does not interfere with thehydrolysis of the beta-lactamase substrate may be used. In a specificembodiment, the buffer does not interfere with either the hydrolysis ofthe beta-lactamase substrate or the activity of one or morebeta-lactamase inhibitors, or both. Non-limiting examples of buffersinclude phosphate, MES buffer, acetate buffer, Tris buffer, ADA buffer,MOPS buffer, and HEPES buffer. In one embodiment, each of thecompositions included in a kit presented herein contains the samebuffer. In another embodiment, each of the compositions included in akit presented herein contains the same or a similar (i.e., within about10% of each other) concentration of the same buffer. In a specificembodiment, a composition comprises 0.05 to 1 ml of phosphate or MESbuffer. In some embodiments, the kits presented herein compriseconcentrated solutions, e.g., 2×, 5× or 10× solutions, of a buffer whichmay be diluted and added to a composition.

In some embodiments, the kits presented herein may include a salinebuffer or a broth. Any broth that does not interfere with either thehydrolysis of the beta-lactamase substrate or the activity of one ormore beta-lactamase inhibitors, or both may be used. In a specificembodiment, the AST broth and/or ID broth utilized with a BD Phoenix™Panel (BD, USA) is included in a kit presented herein. In someembodiments, the kits presented herein comprise concentrated solutions,e.g., 2×, 5× or 10× solutions, of a broth which may be diluted beforeuse.

In a specific embodiment, each composition included in a kit presentedherein has the same or a similar (i.e., within about 10% or about 5% ofeach other) pH. In one embodiment, a composition has a pH of about pH 5to pH 8, preferably about pH 5.5 to about pH 7.5, and more preferablyabout pH 6 to about pH 7.

In some embodiments, a kit presented herein comprises a containercomprising a detectable beta-lactamase substrate, one or more othercontainers comprising one or more inhibitors, and, optionally,instructions. In certain embodiments, a kit presented herein comprises afirst container comprising a detectable beta-lactamase substrate, asecond container comprising a composition comprising a lysis reagent,one or more other containers comprising one or more inhibitors, and,optionally, instructions. In other embodiments, a kit presented hereincomprises a first container comprising a detectable beta-lactamasesubstrate, a second container comprising a composition comprising alysis reagent and an agent that promotes the stabilization of the lysisreagent, one or more other containers comprising one or more inhibitors,and, optionally, instructions. In other embodiments, a kit presentedherein comprises a first container comprising a detectablebeta-lactamase substrate, a second container comprising a compositioncomprising a lysis reagent, an agent that promotes the stabilization ofthe lysis reagent, and an agent that enhances the lysis of a bacterialcell by a lysis reagent, one or more other containers comprising one ormore inhibitors, and, optionally, instructions. In other embodiments, akit presented herein comprises a first container comprising a detectablebeta-lactamase substrate, a second container comprising a compositioncomprising a lysis reagent, a third container comprising an agent thatpromotes the stabilization of the lysis reagent, one or more othercontainers comprising one or more inhibitors, and, optionally,instructions. In other embodiments, a kit presented herein comprises afirst container comprising a detectable beta-lactamase substrate, asecond container comprising a composition comprising a lysis reagent, athird container comprising an agent that promotes the stabilization ofthe lysis reagent, a fourth container comprising an agent that enhancesthe lysis of a bacterial cell by a lysis reagent, one or more othercontainers comprising one or more inhibitors, and, optionally,instructions.

In some embodiments, a kit presented herein comprises a containercomprising a composition and, optionally, instructions, wherein thecomposition comprises a detectable beta-lactamase substrate and one ormore inhibitors. In certain embodiments, a kit presented hereincomprises a container comprising a composition and, optionally,instructions, wherein the composition comprises a detectablebeta-lactamase substrate, one or more inhibitors, and a lysis reagent.In other embodiments, a kit presented herein comprises a containercomprising a composition and, optionally, instructions, wherein thecomposition comprises a detectable beta-lactamase substrate, one or moreinhibitors and a lysis reagent and an agent that promotes thestabilization of the lysis reagent. In other embodiments, a kitpresented herein comprises a container comprising a composition and,optionally, instructions, wherein the composition comprises a detectablebeta-lactamase substrate, one or more inhibitors, a lysis reagent, anagent that promotes the stabilization of the lysis reagent, and an agentthat enhances the lysis of a bacterial cell by a lysis reagent.

The instructions that can be included in the kit may instruct the kituser how to make up specific compositions, such as those describedherein, so that specific beta-lactamases can be detected. For example,the instructions may inform the kit user to make up and add a certainconcentration of a buffer to compositions as well as the concentrationof a detectable beta-lactamase substrate and one or more inhibitors toadd to a composition. In some embodiments, the detectable beta-lactamasesubstrate included in the kit needs to be diluted before being used. Insome embodiments, one or more of the inhibitors needs to be dilutedbefore being used. In some embodiments, the compositions included in thekits presented herein are in a form ready to be contacted with abacterial sample.

The compositions included in the kits can be any form amenable todetection of substrate utilization following contact of a compositionwith a bacterial sample. For example, the compositions included in thekits may be in the form of a liquid composition, an agar plate, a paperdisk, a paper strip, a tablet or dry form in wells. In a specificembodiment, the compositions are liquid compositions included in thekits with each liquid composition comprising a detectable beta-lactamasesubstrate and one or more different beta-lactamase inhibitors. Inanother embodiment, the compositions included in the kits are frozen.

In some embodiments, the compositions included in the kits describedherein are dried and are present on or in a solid support, such as thewell of a plate, panel, cassette or tray, a paper strip, paper disk, ora tube. In certain embodiments, the compositions are dried onto or inthe solid support using heat, e.g., at temperatures of, e.g., 50° C. to100° C., 50° C. to 85° C. 50° C. to 75° C., 60° C. to 75° C. or 60° C.to 70° C. In one embodiment, the compositions are dried onto or in thesolid support using heat under forced air or vacuum conditions at, e.g.,temperatures of, e.g., 50° C. to 100° C., 50° C. to 85° C., 50° C. to75° C., 60° C. to 75° C. or 60° C. to 70° C. In other embodiments, thecompositions are dried onto or in the solid support using alypholization technique. In other embodiments, the compositions aredried onto or in the solid support using a spray drying technique.

In another embodiment, the compositions included in the kits are part ofone agar plate that is divided up into different sections with eachsection comprising a different composition. For example, the agar platemay comprise three sections with each section comprising a compositioncomprising a detectable beta-lactamase substrate and one or moredifferent beta-lactamase inhibitors. In another embodiment, there isonly one composition per agar plate. In other words, each agar plateonly comprises one composition so that two or more agar platescomprising different compositions are utilized in the methods presentedherein.

In another embodiment, the compositions included in the kits are part ofa paper disk or paper strip that is divided up into different sectionswith each section comprising a different composition. For example, thepaper disk or paper strip may comprise three sections with each sectioncomprising a composition comprising a detectable beta-lactamasesubstrate and one or more different beta-lactamase inhibitors. Inanother embodiment, there is only one composition per paper disk orpaper strip. In other words, each paper disk or paper strip onlycomprises one composition so that two or more paper disks or paperstrips comprising different compositions are utilized in the methodspresented herein. In a specific embodiment, the paper disk or paperstrip is filter paper. Non-limiting examples of the types of filterpaper that may be used include Whatman paper (VWR, Pennsylvania,U.S.A.). In another embodiment, the compositions included in the kitsare in dry wells that are hydrated before use. In a specific embodiment,the compositions included in the kits are in a form similar to BBL™Dryslider™ Nitrocefin (BD Diagnostic Systems, USA). In some embodiments,substrate utilization is detected by visual inspection when thecompositions included in the kits are in the form of a paper disk, apaper strip or a dry well.

In certain embodiments, the compositions included in the kits are driedand are present in the wells of a panel, tray, cassette or plate (e.g.,a microtiter plate). In specific embodiments, the compositions includedin the kits are dried and are present in the wells of a tray, cassetteor panel, such as the Phoenix™ Panel (BD, USA), the Vitek® card(bioMerieux, USA), a panel for the BBL™ Crystal™ Identification System(BD, USA), a panel for the Remel RapID™ System (Remel, USA), or aMicroScan panel (Dade Behring, USA). See, e.g., U.S. Pat. No. 5,922,593and Des. 421,498 (each of which are incorporated herein by reference)for a description of panels with wells that the compositions included inthe kits may be dried on or in using, e.g., heat. In some embodiments,the compositions included in the kits are dried and are present in atube for the API biochemical test (bioMerieux, USA).

In a particular embodiment, the compositions included in the kits aredried and are present in the wells of a Phoenix™ Panel (BD, USA) and anautomated system, such as the BD Phoenix™ Automated Microbiology System(BD, USA), is used to detect substrate utilization. See, e.g., U.S. Pat.Nos. 5,922,593, 6,372,485, 6,096,272, and 7,115,384 (each of which areincorporated herein by reference) for a description of an automatedsystem for detection of substrate utilization. In other embodiments, thecompositions included in the kits are dried and are present in the wellsof a panel for the BBL™ Crystal™ Identification System (BD, USA) and anautomated system, such as the BBL™ Crystal™ Identification System (BD,USA), is used to detect substrate utilization. In other embodiments, thecompositions included in the kits are dried and are present in the wellsof a Vitek® card (bioMerieux, USA) and an automated system, such as theVitek® system (bioMerieux, USA), is used to detect substrateutilization. In other embodiments, the compositions included in the kitsare dried and are present in the wells of a MicroScan panel (DadeBehring, USA) and an automated system, such as the MicroScan Walk-Away®system, is used to detect substrate utilization.

In some embodiments, the compositions included in the kits compriseinert ingredients that stabilize the detectable beta-lactamase substrateand/or inhibitors for storage. For example, compositions included in thekits may comprise sucrose to promote stabilization of the compositionsfor storage.

In addition to compositions, the kits presented herein may compriseinstructions for using the kits to detect particular beta-lactamases. Ina specific embodiment, the instructions recommend that positive andnegative controls are run in parallel with test samples. In someembodiments, the kits presented herein comprise a bacterial sample thatis known to not express one or more particular beta-lactamases (i.e., anegative control). In other embodiments, the kits presented hereincomprise a bacterial sample that is known to express one or moreparticular beta-lactamases (i.e., a positive control). In yet otherembodiments, the kits presented herein comprise a bacterial sample thatis known to express one or more particular beta-lactamases (i.e., apositive control) and a bacterial sample that is known to not expressone or more particular beta-lactamases (i.e., a negative control). Insome embodiments, the bacterial control(s) is lypholized.

4.7 Systems

Presented herein are systems comprising a kit or a component(s) of thekits presented herein and a computer program product for use inconjunction with a computer system. In such systems, the computerprogram product can comprise a computer readable storage medium and acomputer program mechanism embedded therein. The computer programmechanism may comprise instructions for evaluating the presence ofparticular beta-lactamases, including class A serine carbapenemases,metallo-beta-lactamases, AmpC beta-lactamases and/or ESBLs, in one or aplurality of bacterial samples. In some embodiments, the computerprogram comprises instructions for evaluating the presence of one, two,three or more of the following: a class A serine carbapenemase, ametallo-beta-lactamase, an AmpC beta-lactamase and/or an ESBL.

In a specific embodiment, the system used for evaluating the presence ofthe beta-lactamases described herein is the same or similar to the BDPhoenix™ Automated Microbiology System (BD, USA). See, e.g., U.S. Pat.Nos. 5,922,593, 6,372,485, 6,096,272, and 7,115,384 (each of which areincorporated herein by reference) for a description of such an automatedsystem. In another embodiment, the system for evaluating the presence ofthe beta-lactamase described herein is the same or similar to the BBL™Crystal™ Identification System (BD, USA). In another embodiment, thesystem used for evaluating the presence of the beta-lactamases describedherein is the same or similar to the Vitek® automated system frombioMerieux. In another embodiment, the system used for evaluating thepresence of the beta-lactamases described herein is the same or similarto the MicroScan Walk-Away® automated system from Dade Behring.

Some systems presented herein comprise a kit or one or more componentsof the kits presented herein, a computer having a central processingunit and a memory coupled to the central processing unit. Some systemspresented herein comprise a kit or one or more components of the kitspresented herein, a computer readable medium (such as a handheldfluorometer or spectrophotometer), a computer having a centralprocessing unit and a memory coupled to the central processing unit. Thememory stores instructions for evaluating the presence of particularbeta-lactamases, including class A serine carbapenemases,metallo-beta-lactamases, AmpC beta-lactamases and ESBLs. In specificembodiments, the memory stores instructions for evaluating the presenceof one, two, three or more of the following: a class A serinecarbapenemases, metallo-beta-lactamases, AmpC beta-lactamases and ESBL.In some embodiments, the memory comprises instructions for transmittingthe results of a method presented herein to a remote computer and theremote computer includes instructions for evaluating ther presence ofone, two, three or more beta-lactamases.

In some embodiments, presented herein is a computer system comprising acomputer readable medium comprising the results of an evaluation for thepresence of a particular beta-lactamase, including class A serinecarbapenemases, metallo-beta-lactamases, AmpC beta-lactamases, and/orESBLs, as described herein. In some embodiments, a computer systempresented herein comprises:

a central processing unit;

a main non-volatile storage unit, for example, a hard disk drive, forstoring software and data, the storage unit controlled by storagecontroller;

a system memory, such as high speed random-access memory (RAM), forstoring system control programs, data and application programs,comprising programs and data loaded from non-volatile storage unit, andmay also include a read-only memory (ROM);

a user interface, comprising one or more input devices (e.g., akeyboard) and display or other output device;

a network interface card for connecting to any wired or wirelesscommunication network (e.g., a wide area network such as the Internet);

an internal bus for interconnecting the aforementioned elements of thesystem; and

a power source to power the aforementioned elements.

Operation of the computer can be controlled primarily by an operatingsystem, which is executed by a central processing unit. The operatingsystem can be stored in the system memory. In addition to the operatingsystem, an implementation system may include: a file system forcontrolling access to the various files and data structures presentedherein; a training data set for use in the construction of one or moredecision rules in accordance with the methods presented herein; a dataanalysis algothrithm module for processing training data andconstructing decision rules; one or more decision rules; a profileevaluation module for determining whether a beta-lactamase is present.

The computer may comprise software program modules and data structures.Each of the data structures can comprise any form of a data storagesystem, including, but not limited to, a flat ASCII or binary file, anExcel spreadsheet, a relational database (e.g., SQL), or an on-lineanalytical processing (OLAP) database (e.g., MDX and/or variantsthereof). In some embodiments, such data structures are each in the formof one or more databases that include a hierarchical structure (e.g., astar schema). In some embodiments, such data structures are each in theform of databases that do not have explicit hierarchy (e.g., dimensiontables that are not hierarchically arranged).

In some embodiments, each of the data structures stored or accessible tothe computer system are single data structures. In other embodiments,such data structures in fact comprise a plurality of data structures(e.g., databases, files, archives) that may or may not all be hosted bythe same computer. For example, in some embodiments, a training data setmay comprise a plurality of Excel spreadsheets that are stored either onthe computer and/or computers that are addressable by the computeracross wide area network. In another example, a training set maycomprise a database that is either stored on the computer or isdistributed across one or more computers that are addressable by thecomputer across a wide area network.

It will be appreciated that many of the modules and data structuresmentioned above can be located on one or more remote computers. Forexample, in some embodiments, web service-type implementations are used.In such embodiments, an evaluation module can reside on a clientcomputer that is in communication with the computer via a network. Insome embodiments, a profile evaluation module can be an interactive webpage.

In some embodiments, a training data set and/or decision rules are on asingle computer and in other embodiments, one or more of such datastructures and modules are hosted by one or more remote computers. Anyarrangement of the data structures and software modules on one or morecomputers is within the scope the systems presented herein so long asthese data structures and software modules are addressable with respectto each other across a network or by other electronic means.

In some embodiments, a digital signal embodied on a carrier wavecomprises data with respect to a method presented herein. In someembodiments, a digital signal embodied on a carrier wave comprises adetermination as to whether a particular beta-lactamase is present in abacterial source. In some embodiments, a graphical user interface isprovided for determining whether a beta-lactamase is present in abacterial source. The graphical user interface may comprise a displayfield for displaying a result encoded in a digital signal embodied on acarrier wave received from a remote computer.

5. EXAMPLES

The examples presented herein demonstrate the accuracy and efficiency ofusing a detectable beta-lactamase substrate and one or morebeta-lactamase inhibitors to detect the presence of specificbeta-lactamases.

5.1 Carbapenemase Detection

This example demonstrates that compositions a comprising detectablebeta-lactamase substrate and one or more beta-lactamase inhibitors maybe used to detect the presence of a carbapenemase in a sample.

5.1.1 Materials & Methods

Chromogenic Beta-Lactamase Assay

Representative E. coli bacterial strains were each streaked on aTrypticase™ Soy Agar with 5% Sheep Blood agar plate and the plate wasincubated at 35° C. for 18 hours. Afterwards, a sample from each platewas added to 1 ml sterile water in a BD 2054 Falcon tube to a turbidityof about 1.6 as measured by a Microscan turbidity reader. 50 μl of acell suspension was added to each of the following 150 μl compositionsto bring the final concentration in each compositions to the following:(i) Composition 1 comprising 50 μM of nitrocefin, 2 mM of cloxacillin,and 75 mM pH 7.0 phosphate buffer; and (ii) Composition 2 comprising 50μM of nitrocefin, 2 mM of cloxacillin, 1 mM of clavulanic acid and 75 mMpH 7.0 phosphate buffer. The color of the nitrocefin was assessedvisually after 10 minutes (for Klebsiella oxytoca strains) or 1 hour(for E. coli and Klebsiella pneumoniae). The hydrolysis of nitrocefin bya beta-lactamase causes the color of the composition to change fromyellow to red.

Imipenem MIC Assay

Imipenem MIC Assay was performed by microbroth dilution method accordingto the CLSI (Clinical and Laboratory Standards Institute) standard.

5.1.2 Results

The results of a chromogenic beta-lactamase assay for representative E.coli strains are summarized in Table 7, below. Table 8, below, comparesthe conclusions based on the beta-lactamase assay described herein tothe results obtained by the imipenem MIC assay and the beta-lactamaseprofile determined previously by isoelectric focusing (IEF) and PCRtesting for the same E. coli strains in Table 7. The conclusions basedon the chromogenic beta-lactamase assay results are consistent with theconclusions based upon the imipenem MIC, IEF and PCR results for thedetection of the presence of a carbapenemase.

TABLE 7 Utilization of Utilization of nitrocefin in nitrocefin inPresence of composition 1 composition 2 carbapenemase 1 − − No 2 + + Yes3 + + Yes 4 + − No 5 + − No 6 + + Yes 7 + − No 8 − − No 9 − − No 10 + −No 11 + − No + indicates that nitrocefin is utilized and changes fromyellow to red − indicates that nitrocefin is not utilized and staysyellow.

TABLE 8 Presence of Beta-lactamase profile carbapenemase based onreference based on chromogenic Imipenem MIC methods (IEF, PCR,beta-lactamase assay (μg/ml) MIC assays) 1 no <=2 C-chromo 2 yes 8 Carb,C-plasmid 3 yes =16 Carb (KPC) 4 no <=2 ESBL, C-chromo 5 no <=2 IRT,C-chromo 6 yes 8 OSBL, Carb 7 no <=2 OSBL, C-plasmid 8 no <=0.25 WT 9 no<=2 WT 10 no <=2 OSBL, C-chromo 11 no <=2 ESBL, C WT means wild-type orwithout beta-lactamase. C-chromo means chromosomal AmpC beta-lactamase.C-plasmid means plasmid-borne AmpC beta-lactamase. Carb meanscarbapenemase. Carb(KPC) means carbapenemase encoded by KPCs (KPC-1,KPC-2, KPC-3 or KPC-4). IRT means inhibitor-resistant TEMbeta-lactamase. ESBL means extended-spectrum beta-lactamase. OSBL meansoriginal-spectrum beta-lactamase. C means either C-chromo or C-plasmidbeta-lactamase.

The results of a chromogenic beta-lactamase assay for representativeKlebsiella pneumoniae strains are summarized in Table 9, below. Table10, below, compares the conclusions based on the beta-lactamase assaydescribed herein to the results obtained by the imipenem MIC assay andthe beta-lactamase profile determined previously by isoelectric focusing(IEF) and PCR testing for the same Klebsiella pneumoniae strains inTable 9. The conclusions based on the chromogenic beta-lactamase assayresults are consistent with the conclusions based upon the imipenem MIC,IEF and PCR results for the detection of the presence of acarbapenemase.

TABLE 9 Utilization of Utilization of nitrocefin in nitrocefin inPresence of composition 1 composition 2 carbapenemase 1 − − no 2 + + yes3 − − no 4 + + yes 5 + − no 6 + − no 7 − − no 8 + − no 9 + + yes 10 + −no 11 + reduced + no 12 + + yes 13 + + yes 14 + − no 15 + + yes 16 + +yes + indicates that nitrocefin is utilized and change from yellow tored. − indicates that nitrocefin is not utilized and stays yellow.

TABLE 10 Presence of carbapenemase based on chromogenic beta- ImipenemMIC Beta-lactamase lactamase assay (μg/ml) Profile 1 no <=2 C-plasmid 2yes =4 ESBL, MBL 3 no <=2 ESBL, C 4 yes =8 ESBL, Carb (KPC) 5 no <=2ESBL, C-plasmid 6 no <=2 ESBL, C-plamid 7 no <=2 WT 8 no <=2 OSBL,C-plasmid 9 yes >16 OSBL, carb 10 no <=2 WT 11 no <=2 OSBL, C-plasmid 12yes >16 MBL 13 yes 4 ESBL, MBL 14 no <=2 ESBL, C-plasmid 15 yes =8Carb(KPC) 16 yes =8 ESBL, Carb(KPC) WT means wild-type or withoutbeta-lactamase. C-plasmid means plasmid-borne AmpC beta-lactamase. Cmeans an AmpC beta-lactamase either plasmid-borne or chromosomal.Carb(KPC) means serine carbapenemase encoded by KPC. ESBL meansextended-spectrum beta-lactamase. OSBL means original spectrumbeta-lactamase. MBL means metallo-beta-lactamase.

The results of a chromogenic beta-lactamase assay for representativeKlebsiella oxytoca strains are summarized in Table 11, below. Table 12,below, compares the conclusions based on the beta-lactamase assaydescribed herein to the results obtained by the imipenem MIC assay andthe beta-lactamase profile determined previously by isoelectric focusing(IEF) and PCR testing for the same Klebsiella oxytoca strains in Table11. The conclusions based on the chromogenic beta-lactamase assayresults are consistent with the conclusions based upon the Imipenem MIC,IEF and PCR results for the detection of the presence of acarbapenemase.

TABLE 11 Presence of Utilization of Utilization of carbapenemasenitrocefin in nitrocefin in based on composition 1 composition 2Chromogenic Assay 1 + − No 2 + − no 3 + + yes 4 − − no + indicates thatnitrocefin is utilized and change from yellow to red. − indicates thatnitrocefin is not utilized and stays yellow.

TABLE 12 Presence of carbapenemase based on chromogenic beta- ImipenemBeta-lactamase lactamase assay MIC Profile 1 no <=2 K1-high 2 no <=2OSBL, K1-high 3 yes >16 OSBL, K1-high, Carb 4 no <=2 WT WT meanswild-type or without beta-lactamase. Carb means carbapenemase. K1-highmeans high level of K1 beta-lactamase. OSBL means original-spectrumbeta-lactamase.

5.2 Detection of a Metallo-Beta-Lactamase

This example demonstrates that compositions comprising a detectablebeta-lactamase substrate and one or more beta-lactamase inhibitors maybe used to detect the presence of a metallo-beta-lactamase in a sample.

5.2.1 Materials & Methods

Chromogenic Beta-Lactamase Assay

Representative Klebsiella pneumoniae strains were each streaked on aTrypticase™ Soy Agar with 5% Sheep Blood agar plate and the plate wasincubated at 35° C. for 18 hours. Afterwards, a sample of Klebsiellapneumoniae from each plate was added to 1 ml of sterile water in a BD2054 Falcon tube to a turbidity of about 1.6 as measured by a Microscanturbidity reader. 50 μl of a cell suspension was added to each of thefollowing 150 μl compositions to bring the final concentration in eachcomposition to be the following (i) Composition 1 comprising 50 μM ofnitrocefin, 2.5 mM of cloxacillin, and 50 mM phosphate buffer pH 7.0;(ii) Composition 2 comprising 50 μM of nitrocefin, 2.5 mM ofcloxacillin, 1 mM of clavulanic acid and 50 mM phosphate buffer pH 7.0;and (iii) Composition 3 comprising 50 μM of nitrocefin, 2.5 mM ofcloxacillin, 1 mM of clavulanic acid, DEDTC at a concentration of 5 mMor 15 mM, DPC at a concentration of 1.5 mM or 4.5 mM or TPEN at aconcentration of 9 mM and 50 mM phosphate buffer pH 7.0. The color ofthe nitrocefin after 30 minutes or 1 hour was assessed visually. Thehydrolysis of nitrocefin by a beta-lactamase causes the color of thecomposition to change from yellow to red.

Imipenem MIC Assay

Imipenem MIC Assay were performed by microbroth dilution methodaccording to the CLSI (Clinical and Laboratory Standards Institute)standard.

5.2.2 Results

The results of a chromogenic beta-lactamase assay for representativeKlebsiella pneumoniae strains are summarized in Table 13, below. In theassay, the affect of two different metal chelators at two differentconcentrations was assessed. Each composition was incubated for 30minutes with a representative strain before the results of the assaywere assessed by visual inspection. Table 14, below, compares theconclusions based on the chromogenic beta-lactamase assay describedherein to the results obtained by the imipenem MIC assay, and thebeta-lactamase profile determined previously by isoelectric focusing(IEF) and PCR testing for the same Klebsiella pneumoniae strains inTable 13. The conclusions based on the chromogenic beta-lactamase assayresults are consistent with the conclusions based upon the imipenem MIC,IEF and PCR results for the detection of the presence of ametallo-beta-lactamase in a sample.

TABLE 13 Comp. #3 Comp. # 3 Comp. #3 Comp. #3 (5 mM (15 mM (1.5 mM (4.5mM Presence of Comp. #1 Comp. #2 DEDTC) DEDTC) DPC DPC) MBL basedUtilization Utilization Utilization Utilization Utilization Utilizationon of of of of of of Chromogenic nitrocefin nitrocefin nitrocefinnitrocefin nitrocefin nitrocefin Assay 1 + + reduced + − − − Yes 2 − − −− − − No 3 + + + + + + No 4 + − − − − − No

TABLE 14 Conclusion from Imipenem beta-lactamase Chromogenic Beta-Organism MIC profile Lactamase Assay 1 KLEPNEP =4 ESBL, MBL MBL 2KLEPNEP <=2 WT WT 3 KLEPNEP >16 OSBL, serine Carbapenemase carbapenemase4 KLEPNEP <=2 ESBL, Beta-lactamase but C-plasmid not carbapenemase MBLmeans metallo-beta-lactamase. WT means wild-type or withoutbeta-lactamase. Bold letters indicate the presence of ametallo-beta-lactamase or a serine carbapenemase which is consistentwith the conclusion from the chromogenic beta-lactamase assay.

The results of a chromogenic beta-lactamase assay for representativeKlebsiella pneumoniae (KLEPNEP) and Pseudomonas aeruginosa (PSEAER)strains are summarized in Table 15, below. In the assay, the affect oftwo different metal chelators was assessed. Each composition wasincubated for 60 minutes with a representative strain before the resultsof the assay were assessed by visual inspection. Table 16, below,compares the conclusions based on the beta-lactamase assay describedherein to the results obtained by the imipenem MIC assay, and thebeta-lactamase profile determined previously by isoelectric focusing(IEF) and PCR testing for the same bacterial strains in Table 15. Theconclusions based on the chromogenic beta-lactamase assay results areconsistent with the conclusions based upon the Imipenem MIC, IEF and PCRresults for the detection of the presence of a metallo-beta-lactamase ora serine carbapenemase in a sample.

TABLE 15 Comp. #3 Comp. #3 Comp. #3 (4.5 mM (15 mM (9 mM Presence ofComp. #1 Comp. #2 DPC) DEDTC) TPEN) MBL based Utilization UtilizationUtilization Utilization Utilization on of of of of of ChromogenicOrganism nitrocefin nitrocefin nitrocefin nitrocefin nitrocefin Assay 1KLEPNEP + + − − reduced + Yes 2 KLEPNEP + + − − − Yes 3KLEPNEP + + + + + No 4 KLEPNEP + − − − reduced + No 5 KLEPENEP − − − − −No 6 PSEAER + + − − reduced + Yes

TABLE 16 Conclusion from Imipenem Beta-lactamase chromogenic beta-Organism MIC profile lactamase assay 1 KLEPNEP 4 ESBL, MBL MBL 2KLEPNEP >16 MBL MBL 3 KLEPNEP =8 ESBL, Class A serine Carbapenemasecarbapenemase 4 KLEPNEP <=2 ESBL, Beta-lactamase but C-plasmid notcarbapenemase 5 KLEPENEP <=2 WT WT or no beta- lacatamase 6 PSEAER >16MBL MBL WT means wild-type. MBL means metallo-beta-lactamase. C-plasmidmeans a plasmid-borne AmpC beta-lactamase. Bold letters indicate thepresence of a metallo-beta-lactamase or a serine carbapenemase which isconsistent with the conclusion from the chromogenic beta-lactamase assay

5.3 Detection of an AmpC Beta-Lactamase

This example demonstrates that compositions comprising a detectablebeta-lactamase substrate and one or more beta-lactamase inhibitors maybe used to detect the presence of an AmpC.

5.3.1 Materials & Methods

Chromogenic Beta-Lactamase Assay

Representative E. coli strains were each streaked on a Trypticase™ SoyAgar with 5% Sheep Blood agar plate and the plate was incubated at 35°C. for 18 hours. Afterwards, a sample of E. coli from each plate wasadded to 1 ml of sterile water in a BD 2054 Falcon tube to a turbidityof about 1.6 as measured by a Microscan turbidity reader. 50 μl of acell suspension was added to each of the following 150 μl compositionsto bring the concentration in each composition to be the following: (i)Composition 1 comprising 50 μM of nitrocefin and 50 mM of phosphatebuffer pH 7.0; (ii) Composition 2 comprising 50 μM of nitrocefin 5 mM ofcloxacillin, and 50 mM of phosphate buffer pH 7.0; (iii) Composition 3comprising 50 μM of nitrocefin, 1 mM of clavulanic acid and 50 mM ofphosphate buffer pH 7.0; and (iv) Composition 4 comprising 50 μM ofnitrocefin, 5 mM of cloxacillin, 1 mM of clavulanic acid and 50 mM ofphosphate buffer pH 7.0. The color of the nitrocefin after 60 minuteswas assessed visually. The hydrolysis of nitrocefin by a beta-lactamasecauses the color of the composition to change from yellow to red.

Cefoxitin MIC Assay

Cefoxitin MIC Assay were performed by microbroth dilution methodaccording to the CLSI (Clinical and Laboratory Standards Institute)standard.

5.3.2 Results

The results of a chromogenic beta-lactamase assay for representative E.coli strains are summarized in Table 17, below. Table 18, below,compares the conclusions based on the beta-lactamase assay describedherein to the results obtained by the cefoxitin MIC assay and thebeta-lactamase profile determined previously by isoelectric focusing(IEF) and PCR testing using the same E. coli strains in Table 17. Theconclusions based on the chromogenic beta-lactamase assay results areconsistent with the conclusions based upon the cefoxitin MIC, IEF andPCR results for the detection of the presence of an AmpC in a sample.

TABLE 17 Comp. Comp. Comp. Comp. Conclusion based on #1 #2 #3 #4Chromogenic Assay 1 − − − − WT 2 + + + − AmpC, OSBL or AmpC, ESBL 3 +− + − AmpC 4 + − − − OSBL or ESBL 5 + + + − AmpC, OSBL or AmpC, ESBL6 + + − − OSBL or ESBL 7 + Reduced + − − OSBL or ESBL 8 + − + − AmpC9 + + + + carbapenemase 10 + − + − AmpC 11 + + + − AmpC, OSBL or AmpC,ESBL WT means wild-type or no beta-lactamase. OSBL meansoriginal-spectrum beta-lactamase. ESBL means extended-spectrumbeta-lactamase. AmpC means AmpC beta-lactamase either plasmid-borne orchromosomal.

TABLE 18 Conclusion based on Cefoxitin Conclusion based chromogenicbeta- MIC on reference methods lactamase assay 1 <=4 WT No detectable β-lactamase 2 >32 OSBL, AmpC, OSBL or C-plasmid AmpC, ESBL 3 >32 OSBL,AmpC C-chromo 4 32 OSBL ESBL or OSBL 5 >32 ESBL, AmpC, OSBL or C-plasmidAmpC, ESBL 6 =32 ESBL, ESBL or OSBL C-chromo 7 =8 ESBL ESBL or OSBL8 >32 C-chromo AmpC 9 >32 Carbapenemase Carbapenemase 10 >32 C-plasmidAmpC 11 >32 OSBL, AmpC, OSBL or C-plasmid AmpC, ESBL WT means wild-typeor beta-lactamase. OSBL means original-spectrum beta-lactamase. ESBLmeans extended-spectrum beta-lactamase. AmpC means an AmpCbeta-lactamase that is either plasmid-borne or chromosomal. C-plasmidmeans plasmid-borne.

5.4 Detection of an ESBL

This example demonstrates that compositions comprising a detectablebeta-lactamase substrate and one or more beta-lactamase inhibitors maybe used to detect the presence of an ESBL.

5.4.1 Materials & Methods

Chromogenic Beta-Lactamase Assay

Representative E. coli and Klebsiella pneumoniae strains from BDcollection were each streaked on a Trypticase™ Soy Agar with 5% SheepBlood agar plate and the plate was incubated at 35° C. for 18 hours.Afterwards, a sample of E. coli or Klebsiella pneumoniae from each platewas added to 1 ml of sterile water in a BD 2054 Falcon tube to a desiredturbidity (reading 1.5 for sample 2-5, 8-10, reading 1.0 for sample 1-2and reading 0.5 for sample 6-7) as measured by a Microscan turbidityreader. 50 μl of a cell suspension was added to each of the following1500 compositions to bring the final concentration in each compositionto be the following: (i) Composition 1 comprising 50 μM of nitrocefinand 50 mM of phosphate buffer pH 7.0; (ii) Composition 2 comprising 50μM of nitrocefin, 0.1 mM of clavulanic acid, and 50 mM of phosphatebuffer pH 7.0; (iii) Composition 3 comprising 50 μM of nitrocefin, 25 mMof cefotaxime and 50 mM of phosphate buffer pH 7.0; and (iv) Composition4 comprising 50 μM of nitrocefin, 1.25 mM of ceftriaxone (Toku-E, Japan)and 50 mM of phosphate buffer pH 7.0. The color of the nitrocefin after20 minutes or 60 minutes was assessed visually. The hydrolysis ofnitrocefin by a beta-lactamase causes the color of the composition tochange from yellow to red.

MIC Assays

MIC Assays of CTX (cefotaxime), CAZ (cefotaxime/clavulanic acid), CAZ(ceftazidime) and CCZ (ceftazidime/clavulanic acid) were performed bymicrobroth dilution method according to the CLSI (Clinical andLaboratory Standards Institute) standard.

5.4.2 Results

The results of a chromogenic beta-lactamase assay for representative E.coli (ESCCOL) and Klebsiella pneumoniae (KLEPNEP) strains are summarizedin Table 19, below. Table 20, below, compares the conclusions based onthe beta-lactamase assay described herein to the results obtained by thecefoxitin MIC assay and the beta-lactamase profile determined previouslyby isoelectric focusing (IEF) and PCR testing using the same strains inTable 19. The conclusions based on the chromogenic beta-lactamase assayresults are consistent with the conclusions based upon the cefoxitinMIC, IEF and PCR results for the detection of the presence of an ESBL ina sample.

TABLE 19 Comp. Comp. Organism #1 #2 Comp. #3 Comp. #4 Conclusion 1ESCCOL + − − − ESBL 2 ESCCOL + − − − ESBL 3 ESCCOL + − + + OSBL 4ESCCOL + − + + OSBL 5 ESCCOL − − − − WT 6 KLEPNEP + − reduced +reduced + ESBL 7 KLEPNEP + − − − ESBL 8 KLEPNEP + − + − OSBL 9 KLEPNEP +− + + OSBL 10 KLEPNEP − − − − WT WT means wild-type or withoutbeta-lactamase. ESBL means extended-spectrum beta-lactamase. OSBL meansoriginal-spectrum beta-lactamase.

TABLE 20 Conclusion based on Conclusion chromogenic CCX CAZ CCZ based onbeta- CTX MIC, MIC, MIC, MIC, reference lactamase Organism μg/ml μg/mlμg/ml μg/ml methods assay 1 ESCCOL =32 <=0.25 >128 <=0.25 ESBL ESBL 2ESCCOL >64 <=0.25 16 <=0.25 ESBL ESBL 3 ESCCOL <=0.25 <=0.25 <=0.25<=0.25 OSBL OSBL 4 ESCCOL <=0.25 <=0.25 <=0.25 <=0.25 OSBL OSBL 5 ESCCOL<=0.25 <=0.25 <=0.25 <=0.25 WT WT 6 KLEPNEP >64 <=0.25 >128 =4 ESBL ESBL7 KLEPNEP >64 <=0.25 =8 <=0.25 ESBL ESBL 8 KLEPNEP <=0.25 <=0.25 <=0.25<=0.25 OSBL OSBL 9 KLEPNEP <=0.25 <=0.25 <=0.25 <=0.25 OSBL OSBL 10KLEPNEP =0.5 =0.5 <=0.25 <=0.25 WT WT WT means wild-type or withoutbeta-lactamase. OSBL means original-spectrum beta-lactamase. ESBL meansextended-spectrum beta-lactamase. Bold letters indicate the presence ofan ESBL, which is consistent with the conclusion from the chromogenicbeta-lactamase assay. Note that assay for sample 6 was finished at 20minutes and the rest samples finish at 1 hour.

5.5 Detection of Beta-Lactamases in the Presence of Lysis Reagents

This example demonstrates that the in situ lysis of bacterial cells andthe detection of beta-lactamases provides a high level of sensitivity ofthe beta-lactamase assay, which can be particularly advantageous whendetecting certain beta-lactamases expressed by certain types of bacteria(e.g., gram negative bacteria).

5.5.1 Materials and Methods

Panel Production.

Stock solutions with nitrocefin, trehalose, and/or reagents used to lysethe bacterial cells in pH6 MES buffer were prepared and dispensed intowells on the bottom part of Phoenix™ panel (BD. USA), with one stocksolution in one well. Panels were then dried in an oven forapproximately 30 min at approximately 70° C. The top part of Phoenixpanel was then attached to the bottom part forming a panel system readyfor inoculation. The concentrations of reagents after rehydrationfollowing Phoenix panel inoculation were 3 mg/ml lysozyme, 1 mM EDTA,and 1% trehalose in 0.1M pH6 MES buffer.

Inoculation and Lysis Testing.

Representative strains of bacteria, such as E. coli and Klebsiellapneumoniae, were each streaked on a Trypticase™ Soy Agar with 5% SheepBlood agar plate (BD, USA) and the plates were incubated at 35° C. for18 hours. Afterwards, colonies from pure culture on each plate wereinoculated into BD Phoenix ID broth (BD, USA) and adjusted to a desiredturbidity of approximately 0.5 MacFarland. The bacterial cell suspensionwas then poured into the ID side of the Phoenix panels that werespecifically made for cell lysis testing. Once inoculated, the panel wasloaded into Phoenix instrument, where nitrocefin hydrolysis rate wasmonitored by colorimetric signals changes every 20 minutes for 16 hours.

Microorganism.

The presence of beta-lactamase in the strains tested herein waspreviously characterized by isoelectric focusing (IEF) gelelectrophoresis, PCR testing, or MIC assays, which were performed bymicrobroth dilution method according to the CLSI (Clinical andLaboratory Standards Institute) standard.

5.5.2 Results

As shown in Table 21, below, some strains that harbor intracellularbeta-lactamase have relatively low nitrocefin activity (<=4 within 10hrs on Phoenix panel) in the absence of lysis reagents. The addition oflysis reagents in Phoenix wells significantly improved the nitrocefinhydrolysis rate by those cells. Some strains exhibited relatively highnitrocefin activity (>4 within 10 hrs on Phoenix panel) in the absenceof lysis reagents. With respect to those strains, the presence of lysisreagents did not result in a change or only resulted in a slightimprovement in the nitrocefin activity. The lysis reagents did notinhibit the nitrofecin activity of the beta-lactamases expressed by thebacterial strains. Neither lysozyme nor EDTA, alone or in combination,hydrolyzed nitrocefin. Without being bound by any theory, it is believedthat the improvement in the nitrocefin hydrolysis rate is primarilybecause more beta-lactamase is released from periplasmic space, andthus, more beta-lactamase is accessible to its substrate, nitrocefin.

TABLE 21 Presence of intracellular NCF NCF activity Sample Organismbeta-lactamase activity with lysis reagent 1 E. coli + 1.9 7.2 2 E.coli + 2.1 7.7 3 E. coli + 2.3 8.1 4 E. coli + 1.9 6.8 5 E. coli + 8.29.1 6 E. coli + 7.2 8.1 7 E. coli + 6.8 8.4 8 E. coli − 1.7 1.8 9Klebsiella + 1.3 4.6 pneumoniae 10 Klebsiella + 3.3 6.3 pneumoniae 11Klebsiella + 3.9 6.1 pneumoniae 12 Klebsiella + 2.6 5.6 pneumoniae 13Klebsiella + 6.7 6.8 pneumoniae 14 Klebsiella + 7.5 8.8 pneumoniae 15Klebsiella + 9.1 9.5 pneumoniae 16 Klebsiella − 1.2 1.8 pneumoniae NCFactivity, the value shown is the maximum nitrocefin hydrolysis ratewithin 10 hrs following Phoenix panel loading into the instrument. Theunit of activity is calculated based on Phoenix signals.

Equivalents

Those skilled in the art will recognize, or be able to ascertain usingno more than routine experimentation, many equivalents to the specificembodiments of the invention described herein. Such equivalents areintended to be encompassed by the following claims.

All publications, patents and patent applications mentioned in thisspecification are herein incorporated by reference into thespecification to the same extent as if each individual publication,patent or patent application was specifically and individually indicatedto be incorporated herein by reference.

Citation or discussion of a reference herein shall not be construed asan admission that such is prior art to the present invention.

1. A kit for detecting the presence of a beta-lactamase, comprising, inone or more containers: (a) a first composition comprising a detectablebeta-lactamase substrate and an AmpC inhibitor; and (b) a secondcomposition comprising a detectable beta-lactamase substrate, an AmpCinhibitor, and a serine beta-lactamase inhibitor in an amount sufficientto inhibit an extended-spectrum beta-lactamase (ESBL) and anoriginal-spectrum beta-lactamase (OSBL) but not a class A serinecarbapenemase.
 2. A kit for detecting the presence of a beta-lactamase,comprising, in one or more containers: (a) a first compositioncomprising a detectable beta-lactamase substrate and an AmpC inhibitor;(b) a second composition comprising a detectable beta-lactamasesubstrate, an AmpC inhibitor, and a serine beta-lactamase inhibitor inan amount sufficient to inhibit an ESBL and an OSBL but not a class Aserine carbapenemase; and (c) a third composition comprising adetectable beta-lactamase substrate, an AmpC inhibitor, a serinebeta-lactamase inhibitor in amount sufficient to inhibit an ESBL and anOSBL but not a class A serine carbapenemase, and a metal chelator. 3.The kit of claim 2 further comprising a fourth composition comprising adetectable beta-lactamase substrate and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase.
 4. A kit for detecting the presence of abeta-lactamase, comprising, in one or more containers: (a) a firstcomposition comprising a detectable beta-lactamase substrate and an AmpCinhibitor; (b) a second composition comprising a detectablebeta-lactamase substrate, an AmpC inhibitor, and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase; and (c) a third composition comprising adetectable beta-lactamase substrate and a serine beta-lactamaseinhibitor in an amount sufficient to inhibit an ESBL and an OSBL but nota class A serine carbapenemase.
 5. The kit of claim 1 further comprisinga third composition comprising a detectable beta-lactamase substrate andan ESBL inhibitor.
 6. The kit of claim 3 further comprising a fifthcomposition comprising a detectable beta-lactamase substrate and an ESBLinhibitor.
 7. The kit of claim 1, 2 or 4, wherein the detectablebeta-lactamase substrate is nitrocefin,pyridinium-2-azo-p-dimethylaniline chromophore,(7R)-3-(((3-carboxy-4-nitrophenyl)thio)methyl)-8-oxo-7-(2-(thiophen-2-yl)acetamido)-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylicacid, or(7R)-7[2-aminothiazol-4-yl]-(z)-2-(1-carboxy-1-methylethoxyimino)acetamido)-3-(2,4-dinitrostyryl)-3-cephem-4-carboxylicacid trifluoroacetate, E-isomer.
 8. The kit of claim 1, 2 or 4, whereinthe AmpC inhibitor is cloxacillin, a salt form of cloxacillin,(2S,3S)-3-(((Z)-2-(((1,5-dihydroxy-4-oxo-1,4-dihydropyridin-2-yl)methoxy)imino)-2-(thiophen-2-yl)ethyl)amino)-2-methyl-4-oxoazetidine-1-sulfonicacid, boronic acid, or a boronic acid derivative.
 9. The kit of claim 1,2 or 4, wherein the serine beta-lactamase inhibitor is clavulanic acid,tazobactum, sulbactam, or a salt form thereof.
 10. The kit of claim 5 or6, wherein the ESBL inhibitor is cefotaxime, ceftazidime, or a salt formthereof.
 11. The kit of claim 2, wherein the metal chelator isdipicolinic acid (DPC), diethyl dithiocarbamate (DEDTC),N,N,N′,N′-tetrakis-(2-pyridylmethyl)-ethylenediamine (TPEN),Ethylenediaminetetraacetic acid (EDTA), 2,3-dimercapto-1-propanesulfonic acid (DMPS) or 1,10-phenathroline.
 12. The kit of claim 1, 2 or4, wherein each composition comprises a lysis reagent.
 13. The kit ofclaim 1, 2 or 4, wherein each composition comprises a lysis reagent andan agent that promotes the stabilization of the lysis reagent.
 14. Thekit of claim 1, 2 or 4, wherein each composition comprises a lysisreagent, an agent that promotes the stabilization of the lysis reagentand an agent that enhances the lysis of a bacterial cell by a lysisreagent.
 15. The kit of claim 1, 2 or 4, wherein each compositioncomprises lysozyme and trehalose.
 16. The kit of claim 1, 2 or 4,wherein each composition comprises lysozyme, trehalose and EDTA.
 17. Thekit of claim 1, 2 or 4, wherein each composition is dried and present onor in a different solid support.
 18. The kit of claim 12, wherein eachcomposition is dried and present on or in a different solid support. 19.The kit of claim 13, wherein each composition is dried and present on orin a different solid support.
 20. The kit of claim 14, wherein eachcomposition is dried and present on or in a different solid support.